1. Risk Adjustment User Group
November 2007

2. Welcome to the November User Group
2007 / 2008
Introduction
Payment Issues
Operations Update
Data Validation
Training Update
Questions and Answers
Closing

3. INTRODUCTION

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

5. PAYMENT PROCESS

6. PAYMENT PROCESS 2007 Final Year Sweep Date New Risk Adjustment Scores
January 31, 2008
New Risk Adjustment Scores
ICD-9 codes for 2009 Payment
Medicaid Eligibility Update
Frailty Scores for 2008
Admission Diagnosis

7. DATA VALIDATION

8. DATA VALIDATION Calendar Year 2006
Medical record reviews are in progress
Medical records will not be accepted after Friday November 16, 2007
Missing medical records
Represent a violation of 42 CFR ; and
Will be considered for payment adjustment.

9. DATA VALIDATION Calendar Year 2005
IVC and SVC medical record review results are undergoing analysis and quality assurance
CMS anticipates distributing results to selected organizations in January 2008

10. DATA VALIDATION Calendar Year 2004 October 24
MA organizations with enrollees in the national sample received their pre-reconciliation medical record review findings
For questions, please contact Chanda McNeal at

11. OPERATIONS UPDATE

12. Submission Deadline
The final submission deadline for claims with dates of service 01/01/2006 through 12/31/2006 is 01/31/2008.
Submit all outstanding claims
Research errors, make possible corrections and resubmit corrected data
CMS is currently reviewing monthly submission data for 2006 to identify organizations that appear to have low data submissions

13. CSSC OPERATIONS UPDATES
502 Edit
Overall average rate for all files submitted during the month of October was 3.06%.
Reminder
The week of 11/11/2007, CMS will suspend processing of all RAPS and PDE files due to routine scheduled maintenance. Files will be held for processing at FERAS/PDFS until after 11/19/ Plans may also choose to hold their files until after 11/19/2007 for submission.

14. CSSC OPERATIONS UPDATES
Week of 11/19/07:
Non-Compliance letters will be issued for all RAPS files received during the following weeks
Week ending 10/19/07
Week ending 10/26/07
Week ending 11/02/07
Week ending 11/09/07

15. TRAINING UPDATE

16. TRAINING UPDATE Enrollment and Payment Training
2007 Monthly Training
Now Registering
Enrollment and Payment Training
November 27
Risk Adjustment Training
December 19

17. *For detailed information
TRAINING UPDATE
*For detailed information
and to
register online
log on to

18. QUESTIONS & ANSWERS

19. CLOSING

20. 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