2009/ 2010 Monthly
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Risk Adjustment
User Group
May 2010
Welcome to the May
User Group
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2010
Introduction
Payment Process
Data Validation
Operations Update
Questions and Answers
Closing
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2010
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INTRODUCTION
2010
User Group Process
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All attendees must pre-register
It is only necessary to register once
Retain unique PIN for all sessions
Session will last for one hour
Session slides will be available by
the Tuesday before the session
• Panel will answer questions during
the Q&A portion of the session
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INTRODUCTION
2010
• The 2010 monthly Risk Adjustment
User Group dates are posted on the
CSSC Operations website.
www.csscoperations.com/new/usergroup/usergroupinfo.html
• Please continue to review the
website for updates to this
information.
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INTRODUCTION
2010
Q&A Resources
• User Group Calls cover 2 risk adjustment
areas: Payment Operations and Data
Validation.
• On the calls, subject matter experts are
available from each area to answer
questions.
• To submit questions outside of User Group:
– Analyst@askriskadjustment.com for Payment
Operations
– Mary.guy@cms.hhs.gov for Data Validation
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PAYMENT PROCESS
2010
• Post transition
• 100% resolved in February 2010
• 96% resolved in March 2010
• 71% resolved in April 2010
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PAYMENT PROCESS
2010
• CMS-HCC Risk Adjustment
Model for 2011
– Reference the factors in the CMSHCC risk adjustment model from
the 2009 Rate Announcement
(published in April 2008).
http://www.cms.gov/MedicareAdvtg
SpecRateStats/Downloads/Announ
cement2009.pdf
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PAYMENT PROCESS
2010
• CMS-HCC ESRD Dialysis Risk
Adjustment Model
– Reference the factors in the CMSHCC ESRD risk adjustment model
from the 2008 Rate Announcement
(published in April 2007).
http://www.cms.gov/MedicareAdv
tgSpecRateStats/Downloads/Ann
ouncement2008.pdf
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PAYMENT PROCESS
2010
• CMS-RxHCC Risk Adjustment Model for
2011
– CMS is implementing the new model in
2011.
– Reference the factors in the CMS-RxHCC
risk adjustment model from the 2011 Rate
Announcement (published in April 2010).
http://www.cms.gov/MedicareAdvtgSp
ecRateStats/Downloads/Announcemen
t2011.pdf
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PAYMENT PROCESS
2010
• Updates to model coefficients versus
Diagnosis Code File.
– The risk adjustment models are not
updated every year.
– If there is an update to the diagnosis codes
used in the Risk Adjustment models, CMS
updates the Diagnosis Code File annually
in October.
http://www.cms.gov/MedicareAdvtgSpe
cRateStats/06_Risk_adjustment.asp#To
pOfP
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PAYMENT PROCESS
FAQ
2010
• When will an age coefficient for
a beneficiary change in a given
year?
For example, a beneficiary
enters a plan on January 1 at the
age of 69 and on February 17 the
beneficiary turns 70.
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2010
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DATA VALIDATION
2010
• CY 2007 Targeted and CY 2008 National
Sample - sample-specific reports
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– Two types (see April 2010 User Group slides
for description of each)
• Technical Assistance Report
• Medical Record Receipt Report
– CMS will release these reports to the plandesignated contacts (MCO and primary and
secondary contacts)
– It is very important that MA organizations
review and report any issues to the Intake
Medical Record Review Contractor (IMRRC)
as directed
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DATA VALIDATION
2010
• CY 2008 Contract-Level Sample
– MA organizations selected for this
sample will be notified
– Notification will be sent to MAO
CEO and MCO
– Training will be provided—
• In-person at CMS, and
• Via Webinar
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DATA VALIDATION
2010
• CY 2008 National Sample
– MAOs notified of selection on Dec. 14,
2009
– Under the Improper Payments Information
Act (IPIA), CMS must annually measure
and report the Part C payment error rate
to OMB
– A key component of the Part C payment
error rate is payment error identified
under RADV
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DATA VALIDATION
2010
• RADV Mailbox – RADV@cms.hhs.gov
– Mailbox recently established
– MAOs may submit RADV questions to
this mailbox
– Questions will be reviewed by the RADV
team and answered via this mailbox
– Mary Guy and Carolyn Kapustij will be
answering general RADV questions
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Operations
2010
2011 Calendar Year RAPS Submission
Timetable
Dates of
Service
Initial
Submission
Deadline
First
Payment
Date
Final
Submission
Deadline
July 1, 2009 –
June 30, 2010
September 3, 2010
January 1, 2011
N/A
January 1, 2010 –
December 31, 2010
March 4, 2011
July 1, 2011
January 31, 2012
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Operations
2010
CSSC Operations will be
closed in observance of
Memorial Day on Monday,
May 31, 2010.
FERAS will be available to accept
files during this period.
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TECHNICAL ASSISTANCE
UPDATES
2010
Next User Group Meeting
June 16, 2010
New participants can register
to attend the UG session
from the www.TARSC.info
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RESOURCES
2010
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Sean Creighton (Director, Division of Risk Adjustment & Payment
Policy)
Sean.Creighton@cms.hhs.gov
Henry Thomas (Training, Project Officer)
Henry.Thomas@cms.hhs.gov
Louis Johnson (FERAS,GTL)
Louis.Johnson@cms.hhs.gov
Chanda.McNeal (RAS Payment)
Chanda.mcneal@cms.hhs.gov
Payment Research
analyst@askriskadjustment.com
Jennifer Harlow (RADV)
Jennifer.Harlow@cms.hhs.gov
Lateefah Hughes (RADV)
Lateefah.Hughes@cms.hhs.gov
Mary Guy (RADV)
mary.guy@cms.hhs.gov
LTC - www.tarsc.info
CSSC - www.csscoperations.com
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