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Risk Adjustment User Group

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Risk Adjustment User Group June 2008 Welcome to the June User Group Introduction Payment Process Operations Update Data Validation Technical Assistance Update ... – PowerPoint PPT presentation

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Title: Risk Adjustment User Group


1
Risk Adjustment User Group
June 2008
2
Welcome to the JuneUser Group
  • Introduction
  • Payment Process
  • Operations Update
  • Data Validation
  • Technical Assistance Update
  • Questions and Answers
  • Closing

3
INTRODUCTION
4
INTRODUCTION
User Group Process
  • 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 QA
    portion of the session

5
INTRODUCTION
  • The 2008 monthly Risk Adjustment User Group Q A
    and Notes documents are posted at the CSSC
    Operations website.
  • Please continue to review the website for updates
    to this information.

www.csscoperations.com/new/usergroup/usergroupinfo
.html
6
PAYMENT PROCESS
7
PAYMENT PROCESS
  • Plan Payment Report (PPR)
  • Also known as the Payment Letter
  • The Automated Plan Payment System (APPS) produces
    the PPR
  • Itemizes final monthly payments to MCO, as part
    of the month-end process

8
PAYMENT PROCESS
  • Includes Summarized Parts A/B and D payments,
    Adjustments, NMEC, COB, User Fees (Jan-Sep each
    year), Premium Settlement Information, monthly
    LIS Amounts, Identifies members with low-income
    cost sharing payment components, etc.
  • For further details review Plan Communications
    User Guide, Ver 3.1 (April 18, 2008), Appendices,
    Section I, pages I-39 through I-43

9
PAYMENT PROCESS
YEAR Budget Neutrality
2006 100
2007 55
2008 40
2009 25
2010 5
2011 0
Budget Neutrality Factor
  • Budget Neutrality Factor is calculated as the
    difference between payments under 100 of the
    risk adjustment method (i.e., under the CMS-HCC
    Model) versus payment under 100 of the
    demographic only method.
  • Phase Out of Budget Neutrality

10
DATA VALIDATION
11
DATA VALIDATION
  • Calendar Year 2007
  • Calendar Year 2006
  • Calendar Year 2005

12
OPERATIONS UPDATES
13
OPERATIONS
  • QUESTION
  • The Medicare Advantage (MA) plan has a death
    certificate, but the provider continues to submit
    the encounter with the date of discharge after
    the date of death. How do we resolve this issue?
  • ANSWER
  • If the date of discharge is after the date of
    death, then RAPS will reject the claim. Normally,
    MA plans may not change the date of discharge on
    an inpatient claim. However, in the circumstance
    that a hospital refuses to change the discharge
    date or through date to the date of death, then
    the MA may make this change.
  • Any other changes to the from and through dates
    must come from the hospital only (Reference
    February, 2005 User Group QA, Data Submission,
    Question 4).

14
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15
TECHNICAL ASSISTANCE UPDATES
2008 Monthly Technical Assistance Sessions
  • Risk Adjustment Session
  • June 25th
  • Enrollment Payment Session
  • July 30th

Register today at www.tarsc.info
16
TECHNICAL ASSISTANCE UPDATES
  • Next User Group Session
  • July 16, 2008

Sessions held on Wednesdays at 130 pm Eastern
Standard Time
17
REGIONAL TECHNICAL ASSISTANCE SESSIONS
  • Registration Is Now Open!
  • CHICAGO, IL
  • August 11 August 14
  • LAS VEGAS, NV
  • August 26 August 29
  • NEW ORLEANS, LA
  • September 9 September 10


18
TECHNICAL ASSISTANCE UPDATES
  • For detailed information
  • and to
  • register online
  • log on to
  • www.tarsc.info
  • Technical Assistance
  • Registration Service Center

19
QUESTIONS ANSWERS
20
CLOSING
21
RESOURCES
  • Sean Creighton (Director, Division Risk
    Adjustment Operations) sean.creighton_at_cms.hhs.gov
  • Henry Thomas (Training, Project Officer)
    henry.thomas_at_cms.hhs.gov
  • Lateefah Hughes (Data Validation, Team Lead)
    lateefah.hughes_at_cms.hhs.gov
  • Louis Johnson (FERAS,GTL) louis.johnson_at_cms.hhs.go
    v
  • Chanda McNeal (Payment Issues)
    raf_payment_questions_at_cms.hhs.gov
  • LTC www.tarsc.info
  • CSSC www.csscoperations.com
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