1. Risk Adjustment User Group
April 2009

2. Welcome to the April 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 Q&A 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.

6. PAYMENT PROCESS

7. PAYMENT PROCESS Prior to transition 38% response rate Post transition
73% resolved in March
67% resolved in February

8. PAYMENT PROCESS Question 1
Where can plans locate the coefficients for the CMS-HCC End-Stage Renal Disease Model, the CMS-HCC Community Model, and the CMS-HCC Institutional Model for payment years 2008 and 2009? 8

9. PAYMENT PROCESS Question 2
What does the risk score mean on the Part C Risk Adjustment Model Output Report (MOR) for a given month? 9

10. PAYMENT PROCESS 2010 Advanced Notice Frailty Adjustment
Normalization Factors
Budget Neutrality
Adjustment for MA Coding Pattern Differences
ESRD Payments
IME Phase Out
Network Areas for PFFS Plans in Plan Year 2011
Continuation of Clinical Trial Policy
Adjustment to FFS Per Capita Costs for VA-DOD costs
Calculation and Source of MSP Factors

11. PAYMENT PROCESS Notices:
Final (April 7, 2008):
Advance (February 20, 2009):
Expected release 2010 Final Notice April 2009

12. DATA VALIDATION

13. DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008)
Analyses in progress
Targeted RADV (notified Nov. 10, 2008)
Instructions Packet to be distributed
Selected plans to be notified via when packet is released
Plans will have 12 weeks to submit medical records
Random RADV
To be implemented

14. DATA VALIDATION CY 2007 (cont’d)
National Sample (notified December 3, 2008)
Medical record submission deadline was Friday, February 27th
A plan-specific Tracking Report that confirms medical records and coversheets received has been released to plan-designated contacts
Please review the Tracking Report for inconsistencies and notify HMS as instructed

15. DATA VALIDATION CY 2007 (cont’d)
Submit your RADV-related questions to Ann Marshall on the RADV team at 15 15

16. OPERATIONS UPDATES

17. Operations: Reports Overview
FERAS - Provides the status of accepted or rejected of submitted files, and identifies the rationale for the rejections.
RAPS Return File - Contains the entire submitted transactions, and identifies the 300, 400, and 500 level errors.
RAPS Transaction Error Report - Identifies errors found in CCC records during the RAPS processing cycle. Displays only 300, 400, and 500 level error codes
RAPS Transaction Summary Report - Summarizes all transaction submitted.

18. Operations: Reports Overview
Reports cont.
RAPS Monthly Plan Activity Report – Provides the monthly summary of submitted transactions, which are stratified by Submitter ID and Plan Number.
RAPS Cumulative Plan Activity Report - Contains monthly cumulative list of transactions, which are stratified by Submitter ID and Plan Number
RAPS Monthly Error Frequency Report – Provides the monthly summary of all errors in the files that were submitted in test and/or production.
RAPS Quarterly Error Frequency Report - Provides the quarterly summary of all errors on all files that were submitted within a 3-month period

19. TECHNICAL ASSISTANCE
UPDATES

20. TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
May 20, 2009

21. QUESTIONS & ANSWERS

22. CLOSING

23. RESOURCES
Sean Creighton (Director, Division Risk Adjustment Operations)
Henry Thomas (Training, Project Officer)
Louis Johnson (FERAS,GTL)
Payment Research
Lateefah Hughes (RADV)
Ann Marshall (RADV)
LTC
CSSC