2006/2007 Monthly

1

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

2006/2007 Monthly

Risk Adjustment User Group

Session

A training initiative presented by JANUARY 2007

2

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Welcome to the January User Group

• Introduction

• Payment Process

• Data Validation

• Operations Update

• Training Update

• Questions and Answers

• Closing

3

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

4

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Introduction

• All attendees must pre-register.• Panel will entertain questions during the

Q&A portion of the session.• Sessions will run for 60 minutes.• Q&A document and session notes will be

available within 2 weeks after the session. • Session slides will be available by the

Tuesday prior to the session.

User Group Process:

5

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

6

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Payment Process

• 2006 Reconciliation Payment – Deadline

• January 31, 2007

– Dates of Service• January 2005 through December 2005

7

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

8

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Data Validation

• Calendar Year 2005– December 2006

• Coders began medical record review• Plans with <95% medical record response

rate received a verification email from IPRO

– January 2007• Coders continue medical record review

9

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Data Validation (cont’d)

• Calendar Year 2004

– Late January: Expect completion of QA

to confirm medical record review results.

– Late February: Anticipate communicating

results to selected MA organizations.

10

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

11

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Who Should Submit RAPS Data?

• Risk Plans (Also known as Coordinate Care Plans (CCP) and Health Maintenance Organizations (HMO)

• COST • HCPP • PACE (Program for the All Inclusive Care of the Elderly)• PFFS (Private Fee for Service Plans)• PPO (Preferred Provider Organizations)• RPPO (Regional Preferred Provider Organizations)• PSO (Provider Sponsored Organizations)• DEMO (Demonstration Projects)• DEMP (PPO Demos, that is demonstration projects using

the PPO model)• DEMC (Cost Demos, that is demonstration projects using

a cost payment scheme)

12

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

• SNP (Special Needs Plans)• RFB (Religious Fraternal Benefit)

Plans• MSA (Medical Savings Account) Plans

Reference: Medicare Advantage Manual Publication 100-16; Chapter 1 (General Provisions)

Who Should Submit RAPS Data? (cont’d)

13

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

• The processing systems (FERAS and RAPS) send reports to the submitter’s mailbox where they remain for 14 days. The systems automatically delete reports from the mailbox after 14 days, but MA organizations can request restored reports through the Customer Service and Support Center (CSSC) at 1-877-534-2772.

• When requesting a restored report, the following information is required:

Submitter Number

File ID

Date of Submission

Requesting Reports From CSSC

14

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

502 Error Rates

Monthly 502 Error Rate of Diagnosis Clusters Submitted

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000Ja

n-06

Feb-

06

Mar

-06

Apr-0

6

May

-06

Jun-

06

Jul-0

6

Aug-

06

Sep-

06

Oct

-06

Nov-

06

Dec-

06

Total DX Submitted 17,741,703 31,092,617 31,299,685 19,145,729 40,130,297 18,023,686 25,515,273 51,893,165 29,767,388 25,727,296 28,368,114 32,160,101

502 Cluster Count 5,524,529 11,667,180 10,213,918 3,658,003 9,340,662 3,621,081 6,376,643 13,384,636 7,849,029 5,445,186 7,864,758 11,116,347

502 Error Rate 31.14% 37.52% 32.63% 19.11% 23.28% 20.09% 24.99% 25.79% 26.37% 21.17% 27.72% 34.57%

Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06

15

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

16

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Training Update

• Enrollment and Payment Training– March 27, 2007– April 24, 2007

• Risk Adjustment Training– March 28, 2007– April 25, 2007

2007 Monthly Training Schedule

17

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

18

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

19

2006/2007 Monthly

Risk Adjustment User Group Meeting

JANU

ARY 2007

A training

initiative

presented by

Resources

• Sean Creighton (Director) sean.creighton@cms.hhs.gov

• Henry Thomas (Training, Project Officer) henry.thomas@cms.hhs.gov

• Lateefah Hughes (Data Validation, Team Lead) lateefah.hughes@cms.hhs.gov

• Thomas Kornfield (Risk Adjustment Model) thomas.kornfield@cms.hhs.gov

• Louis Johnson (FERAS, Risk Adjustment Coordination) louis.johnson@cms.hhs.gov

• Chanda McNeal (Payment Issues)chanda.mcneal@cms.hhs.gov

• LTC www.Medicaretraining.net

• CSSC www.csscoperations.com