Risk Adjustment User Group
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A training initiative presented by 2007 / 2008 Monthly Risk Adjustment User Group June 2008
description
Risk Adjustment User Group. June 2008. Welcome to the June User Group. Introduction Payment Process Operations Update Data Validation Technical Assistance Update Questions and Answers Closing. INTRODUCTION. INTRODUCTION. User Group Process. All attendees must pre-register - PowerPoint PPT Presentation
Transcript of Risk Adjustment User Group
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008
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Risk Adjustment User Group
June 2008
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Welcome to the JuneUser Group
• Introduction
• Payment Process
• Operations Update
• Data Validation
• Technical Assistance Update
• Questions and Answers
• Closing
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INTRODUCTION
• 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
User Group Process
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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
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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
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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
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PAYMENT PROCESS
• 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
YEARBudget
Neutrality %
2006 100
2007 55
2008 40
2009 25
2010 5
2011 0
Budget Neutrality Factor
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DATA VALIDATION
• Calendar Year 2007
• Calendar Year 2006
• Calendar Year 2005
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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 Q&A, Data Submission, Question #4).
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TECHNICAL ASSISTANCE UPDATES
2008 Monthly Technical Assistance Sessions
• Risk Adjustment Session
– June 25th
• Enrollment & Payment Session
– July 30th
Register today at www.tarsc.info
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TECHNICAL ASSISTANCE UPDATES
Next User Group SessionNext User Group Session
July 16, 2008
Sessions held on Wednesdays at 1:30 pm Eastern Standard Time
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Registration Is Now Open! Registration Is Now Open!
CHICAGO, ILCHICAGO, IL
August 11 – August 14
LAS VEGAS, NVLAS VEGAS, NV
August 26 – August 29
NEW ORLEANS, LANEW ORLEANS, LA
September 9 – September 10
REGIONAL TECHNICAL ASSISTANCE SESSIONS
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TECHNICAL ASSISTANCE UPDATES
*For detailed information
and to
register online
log on to
www.tarsc.info
Technical Assistance
Registration Service Center
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RESOURCES
• Sean Creighton (Director, Division Risk Adjustment Operations) [email protected]
• Henry Thomas (Training, Project Officer) [email protected]
• Lateefah Hughes (Data Validation, Team Lead) [email protected]
• Louis Johnson (FERAS,GTL) [email protected]
• Chanda McNeal (Payment Issues) [email protected]
• LTC www.tarsc.info• CSSC www.csscoperations.com
