1. Risk Adjustment User Group
May 2010

2. Welcome to the May 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 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.

6. 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:
for Payment Operations
for Data Validation

7. PAYMENT PROCESS

8. PAYMENT PROCESS Post transition 100% resolved in February 2010
96% resolved in March 2010
71% resolved in April 2010

9. PAYMENT PROCESS CMS-HCC Risk Adjustment Model for 2011
Reference the factors in the CMS-HCC risk adjustment model from the 2009 Rate Announcement (published in April 2008).

10. PAYMENT PROCESS CMS-HCC ESRD Dialysis Risk Adjustment Model
Reference the factors in the CMS-HCC ESRD risk adjustment model from the 2008 Rate Announcement (published in April 2007).

11. PAYMENT PROCESS CMS-RxHCC Risk Adjustment Model for 2011
CMS is implementing the new model in 2011.
Reference the factors in the CMS-RxHCC risk adjustment model from the 2011 Rate Announcement (published in April 2010).

12. PAYMENT PROCESS
Updates to model coefficients versus Diagnosis Code File.
The risk adjustment models are not updated every year.
If there is an update to the diagnosis codes used in the Risk Adjustment models, CMS updates the Diagnosis Code File annually in October.

13. PAYMENT PROCESS FAQ
When will an age coefficient for a beneficiary change in a given year? 
For example, a beneficiary enters a plan on January 1 at the age of 69 and on February 17 the beneficiary turns 70.

14. DATA VALIDATION

15. DATA VALIDATION
CY 2007 Targeted and CY 2008 National Sample - sample-specific reports
Two types (see April 2010 User Group slides for description of each)
Technical Assistance Report
Medical Record Receipt Report
CMS will release these reports to the plan-designated contacts (MCO and primary and secondary contacts)
It is very important that MA organizations review and report any issues to the Intake Medical Record Review Contractor (IMRRC) as directed

16. DATA VALIDATION CY 2008 Contract-Level Sample
MA organizations selected for this sample will be notified
Notification will be sent to MAO CEO and MCO
Training will be provided—
In-person at CMS, and
Via Webinar

17. DATA VALIDATION CY 2008 National Sample
MAOs notified of selection on Dec. 14, 2009
Under the Improper Payments Information Act (IPIA), CMS must annually measure and report the Part C payment error rate to OMB
A key component of the Part C payment error rate is payment error identified under RADV

18. DATA VALIDATION RADV Mailbox – RADV@cms.hhs.gov
Mailbox recently established
MAOs may submit RADV questions to this mailbox
Questions will be reviewed by the RADV team and answered via this mailbox
Mary Guy and Carolyn Kapustij will be answering general RADV questions

19. OPERATIONS UPDATES

20. 2011 Calendar Year RAPS Submission Timetable
Operations
2011 Calendar Year RAPS Submission Timetable
Dates of Service
Initial Submission Deadline
First Payment Date
Final Submission Deadline
July 1, 2009 –
June 30, 2010
September 3, 2010
January 1, 2011
N/A
January 1, 2010 – December 31, 2010
March 4, 2011
July 1, 2011
January 31, 2012

21. FERAS will be available to accept files during this period.
Operations
CSSC Operations will be closed in observance of Memorial Day on Monday, May 31, 2010.
FERAS will be available to accept files during this period.

22. TECHNICAL ASSISTANCE
UPDATES

23. TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
June 16, 2010
New participants can register to attend the UG session from the

24. QUESTIONS & ANSWERS

25. CLOSING

26. RESOURCES
Sean Creighton (Director, Division of Risk Adjustment & Payment Policy)
Henry Thomas (Training, Project Officer)
Louis Johnson (FERAS,GTL)
Chanda.McNeal (RAS Payment)
Payment Research
Jennifer Harlow (RADV)
Lateefah Hughes (RADV)
Mary Guy (RADV)
LTC -
CSSC -