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Risk Adjustment User Group

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Title: Welcome to the November User Group Author: Krista Burrell Last modified by: BCBSSC Created Date: 10/30/2007 7:55:14 PM Document presentation format – PowerPoint PPT presentation

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Title: Risk Adjustment User Group


1
Risk Adjustment User Group
June 2010
2
Welcome to the June User Group
  • Introduction
  • Payment Process
  • Data Validation
  • Operations 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 2010 monthly Risk Adjustment User Group dates
    are posted on the CSSC Operations website.
  • Please continue to review the website for updates
    to this information.

www.csscoperations.com/new/usergroup/usergroupinfo
.html
6
INTRODUCTION
  • QA 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_at_askriskadjustment.com for Payment
    Operations
  • RADV_at_cms.hhs.gov for Data Validation

7
PAYMENT PROCESS
8
PAYMENT PROCESS
  • Post transition
  • 100 resolved in March 2010
  • 100 resolved in April 2010
  • 90 resolved in May 2010

9
PAYMENT PROCESS
Mid-Year Model Run for 2010 Payment in July
2010 Covers Dates of Service 1/1/09
12/31/09 Final Reconciliation for 2009 Payment in
August 2010 Covers Dates of Service 1/1/08
12/31/08
10
PAYMENT PROCESS FAQ

Question How often does CMS update the
beneficiary Risk Adjustment Factor Type (RAFT)
and during what timeframes annually?
11
DATA VALIDATION
12
DATA VALIDATION
  • CY 2007 Targeted Sample
  • Technical Assistance Report will soon be
    released
  • TA Report will identify inconsistencies in date
    of service and/or provider type as well as other
    inconsistencies (e.g., obscured text).
  • CMS will hold a teleconference to coincide with
    the distribution of TA Reports
  • CMS will discuss
  • Format of the report
  • Time period and requirements for plan response
  • Importance of reviewing and reporting any issues
    to the IMRRC
  • Date, time, and dial-in information will be
    forthcoming.
  • TA Reports and teleconference information will be
    sent by the IMRRC (Healthcare Management
    Solutions) via email to CY 2007 Targeted Sample
    plan-designated contacts.
  • A Medical Record Receipt Report will also be
    distributed.

13
DATA VALIDATION
CY 2008 National Sample MAOs were 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 Medical Record Receipt Report Released
on June 3, 2010 to CY 2008 National Sample
plan-designated contacts (MCO and
primary/secondary contacts) Deadline for response
was June 8, 2010. Medical record review Is
nearing completion, and CMS will analyze data.
14
DATA VALIDATION
  • CY 2008 Contract-Level Sample
  • MA organizations (MAOs) 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

15
DATA VALIDATION
  • RADV Mailbox RADV_at_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

16
OPERATIONS UPDATES
17
Operations
  • CSSC Can Help With
  • Verification of acceptance on file submissions.
  • Technical issues and problems encountered with
    the submission of risk adjustment data.
  • Restoring Risk Adjustment Reports
  • Verification of data, addressing problems,
    offering technical assistance, and developing
    action plans through the monitoring and review of
    the plans data..

18
Operations
  • FAQ
  • Q Can the reconciliation payment date be
    included on the Annual Risk Adjustment Submission
    Timetable?
  • A Future reconciliation payment dates have not
    been determined therefore, this information is
    not included on the submission timetable.

19
(No Transcript)
20
TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting July 21, 2010 New
participants can register to attend the UG
session from the www.TARSC.info
21
QUESTIONS ANSWERS
22
CLOSING
23
RESOURCES
  • Sean Creighton (Director, Division of Risk
    Adjustment Payment Policy)
  • Sean.Creighton_at_cms.hhs.gov
  • Henry Thomas (Training, Project Officer)
  • Henry.Thomas_at_cms.hhs.gov
  • Louis Johnson (FERAS,GTL)
  • Louis.Johnson_at_cms.hhs.gov
  • Chanda McNeal (RAS Payment)
  • Chanda.mcneal_at_cms.hhs.gov
  • Jennifer Harlow (RADV)
  • Jennifer.Harlow_at_cms.hhs.gov
  • Lateefah Hughes (RADV)
  • Lateefah.Hughes_at_cms.hhs.gov
  • Mary Guy (RADV)
  • mary.guy_at_cms.hhs.gov
  • Payment Research analyst_at_askriskadjustment.com
  • RADV Questions RADV_at_cms.hhs.gov
  • CSSC www.csscoperations.com
  • LTC www.tarsc.info
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