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Risk Adjustment User Group

January 2010

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Welcome to the JanuaryUser Group

• Introduction

• Payment Process

• Data Validation

• Operations 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 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

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INTRODUCTION

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– ann.marshall@cms.hhs.gov for Data Validation

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PAYMENT PROCESS

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Payment Research Response

Rate

• 100% resolved in October

• 96% resolved in November

• 85% resolved in December

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PAYMENT PROCESS

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Question – Why doesn’t the MOR show all HCCs accepted by RAPS for a beneficiary?

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DATA VALIDATION

CY 2007 • Pilot RADV (notified June 20, 2008)

– Deadline for submission of corrective medical records and attestations was Sept. 16, 2009.

– Medical Record Receipt Reports• Distribution did not occur in December• CMS will soon release these reports to

selected MA organizations.

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DATA VALIDATION

CY 2007 • Targeted RADV (notified Nov.10,

2008)– Selected MAOs received—

• Instructions packet for audit on Oct. 19, 2009• Training on Oct. 23, 2009

– CMS will soon distribute• Technical Assistance Reports to help with

addressing potential issues with the medical record documentation which may impact medical record review findings for your plan

• Medical Record Receipt Reports to inform MAOs about medical record submissions to date.

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DATA VALIDATION

Plans Notified of Stage Assignment

MAOs Received Encrypted CD w/Contract-Specific Data

Deadline for Submission of Coversheets, Attestations, and Medical Records*

Stage I Oct. 23, 2009 Nov. 10, 2009 Feb. 9, 2010

Stage II Nov. 13, 2009 Nov. 19, 2009 Feb. 18, 2010

Stage III Dec. 4, 2009 Dec. 10, 2009 March 11, 2010

* Submission Deadline is 11:59 p.m. Eastern

CY 2007• Targeted RADV - Important Dates

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DATA VALIDATION

CY 2008• National RADV (notified Dec. 14,

2009)—under the Improper Payments and Information Act (IPIA), CMS must annually measure and report the Part C payment error rate– CMS recently completed its analysis, reporting a 15.4

percent Part C national error rate for payment year 2007• CMS will report a Part C payment error rate for 2008

at the end of fiscal year 2010• CMS requests plans’ best efforts to assist in

correcting and improving payment error.

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DATA VALIDATION

CY 2008• National RADV (cont’d)

– Contact Information Sheets were completed by MA organizations via electronic entry process.

– Instructions and enrollee data files were distributed by traceable carrier to Primary Contacts on Dec. 17, 2009.

– Teleconference for selected MA organizations in this sample was held on Dec. 18, 2009.

– Deadline for submission of medical records (medical records, coversheets, and attestations) is March 12, 2010.

• Plans may submit medical records via VPN, electronic media (e.g., USB, CD, DVD), fax, or hardcopy.

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DATA VALIDATION

CY 2007 Targeted & CY 2008 National RADV

• Tips– Attestations—provide the treating

physician with:• A sample completed attestation; and • A cover note identifying the date of service

requiring attestation.

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DATA VALIDATION

CY 2007 Targeted & CY 2008 National• Tips

– Requests for medical records—ensure that:

• Providers receive all information needed to comply; and

• Your complete request is received by the intended recipient—CMS contacted by multiple providers who receive incomplete medical record requests and are unable to determine—

– MA organization– Patient information– Specific date(s) of service required.

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DATA VALIDATION

• General Reminder--Observe CMS Requirements to Submit Documentation– MA organizations must ensure confidentiality of

beneficiary information when sending protected health information (PHI) and/or personal identifiable information (PII) contained in medical records, attestations, and coversheets.

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DATA VALIDATION

• General Reminder (cont’d)– Do not submit any medical records via email. This

may compromise PHI and/or PII and will be reported to the CMS Security Division as described in Security and Privacy Reminders and Clarification of Reporting Procedures (12/16/2008 CPC memorandum, available on the CMS Health Plan Management System website).

– All submitted medical records must comply with the medical record requirements set forth in the Instructions Packet.

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OPERATIONS

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Important Message Regarding Edit 501

Risk Adjustment plans will no longer receive informational edit 501 (Valid diagnosis but not relevant diagnosis for Risk Adjustment during this service period).

CMS has determined that Error Code 501 is not valid in the current Risk Adjustment environment and will be retired January 1, 2010.

Please contact CSSC Operations for further assistance at 1-877-534-2772.

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OPERATIONS

• As a reminder, the deadline for submission of Calendar Year 2008 data (1/1/08 through 12/31/08) is January 31, 2010.  This deadline date occurs on a Sunday.

• To ensure sufficient time to edit discrepancies in submitted 2008 data, CMS is suggesting submitting your 2008 data by close of business Friday, January 29, 2010.

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RAPS Deadline Reminder

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OPERATIONS

• Frequently Asked Question

• Q:    How frequently are RAPS Return file Reports delivered to the submitters inbox?

•A: RAPS Return Files are delivered to the submitter the next business day following submission.

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TECHNICAL ASSISTANCE UPDATES

Next User Group Meeting

February 17, 2010

New participants can register to attend the UG session

from the www.TARSC.info

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• Sean Creighton (Director, 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• Ann Marshall (RADV) Ann.marshall@cms.hhs.gov• LTC www.tarsc.info• CSSC www.csscoperations.com

RESOURCES