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
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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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:
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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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
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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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
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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.
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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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)
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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)
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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
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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
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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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
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
JANU
ARY 2007
A training
initiative
presented by
Resources
• Sean Creighton (Director) [email protected]
• Henry Thomas (Training, Project Officer) [email protected]
• Lateefah Hughes (Data Validation, Team Lead) [email protected]
• Thomas Kornfield (Risk Adjustment Model) [email protected]
• Louis Johnson (FERAS, Risk Adjustment Coordination) [email protected]
• Chanda McNeal (Payment Issues)[email protected]
• LTC www.Medicaretraining.net
• CSSC www.csscoperations.com