1. Risk Adjustment User Group Session
2006/2007 Monthly
Risk Adjustment User Group Session
A training initiative presented by
SEPTEMBER 2007 1

2. Welcome to the September User Group
Introduction
Payment Process
Data Validation
Operations Update
Training Update
Questions and Answers
Closing 2

3. INTRODUCTION 3

4. Introduction User Group Process All attendees must pre-register
Panel will answer questions during the Q&A portion of the session
Session will last for one hour
Q&A document and session notes will be available within 2 weeks after the session
Session slides will be available by the Tuesday before the session 4

5. PAYMENT PROCESS 5

6. Payment Process September Submission Deadline
Submission Deadline – September 7, 2007
DOS – July 1, 2006 thru June 30, 2007
Payment Date – January 1, 2008 6

7. DATA VALIDATION 7

8. Data Validation Calendar Year 2006
August 17, 2007 was the medical record submission deadline
Ascellon will continue to accept medical records until medical record log-in process is completed
CMS-HCCs and RxHCCs with missing medical records:
Represent a violation of 42 CFR § ; AND
Will be considered for payment adjustments
Organizations must immediately submit any outstanding medical records 8

9. Data Validation (cont’d)
Calendar Year 2005
Second Validation Contractor (SVC) completed its review of medical records
Responses were received from organizations contacted by CMS to confirm physician data sources
IVC and SVC medical record review results merged, and currently undergoing analysis and quality assurance
CMS anticipates releasing results to selected organizations in the fall of 2007 9

10. Data Validation (cont’d)
Calendar Year 2004
July 12, 2007: Disseminated plan-specific findings to MA organizations in the targeted sample
August 29, 2007: Conducted teleconference to communicate the CY 2004 pre-reconciled medical record review national results
Mid-October 2007: Anticipate mailing pre-reconciled findings to MA organizations with enrollees selected for the national sample 10

11. OPERATIONS UPDATE 11

12. General Information Stand-alone PDP
Stand-alone PDP plans are not required to submit Risk Adjustment data. They are, however, required to submit prescription drug data
Duplicate 502 Status
August 2007
The percentage rate for all files received = 7.72% 12

13. TRAINING UPDATE 13

14. 2007 Monthly Training Schedule
Training Update
2007 Monthly Training Schedule
Now Registering
Enrollment and Payment Training
September 25
Risk Adjustment Training
September 26 14

15. 2007 Monthly Training Schedule* *For detailed information
Training Update
2007 Monthly Training Schedule*
*For detailed information
and to
register online
log on to 15

16. QUESTIONS AND ANSWERS 16

17. CLOSING 17

18. Resources
Sean Creighton (Director, Division Risk Adjustment Operations)
Henry Thomas (Training, Project Officer)
Lateefah Hughes (Data Validation, Team Lead)
Louis Johnson (FERAS, Risk Adjustment Coordination)
Chanda McNeal (Payment Issues)
LTC
CSSC 18