2006/2007 monthly
DESCRIPTION
2006/2007 Monthly. Risk Adjustment User Group Session. A training initiative presented by. OCTOBER 2007. Welcome to the October User Group. Introduction Payment Process Data Validation Operations Update Training Update Questions and Answers Closing. INTRODUCTION. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
2006/2007 Monthly
Risk Adjustment User Group
Session
A training initiative presented by
OCTOBER 2007
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Welcome to the October 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
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Introduction
• 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
User Group Process
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Payment Process
• Medicaid Eligibility
• 2008 Initial Year Sweep Date
– September 21, 2007
• 2009 Payment
• Original Reason for Entitlement (OREC) Values
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Data Validation
Calendar Year 2006• August 17, 2007 was the Medical record
submission deadline• MA organizations must immediately
submit any outstanding medical records• Missing medical records
– Represent a violation of 42 CFR § 422.310
AND– Will be considered for payment adjustments
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Data Validation (cont’d)
Calendar Year 2005• IVC and SVC medical record review
results merged• Data undergoing analysis and quality
assurance• CMS anticipates distributing results to
selected organizations in late fall of 2007
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Data Validation (cont’d)
Calendar Year 2004• Mid to late October 2007
– Anticipate mailing pre-reconciled findings to MA organizations with enrollees selected for the national sample
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Submission Deadline
Next submission deadline for dates of service 01/01/2006 through 12/31/2006:
•January 31, 2008
oSubmit all outstanding claims
oResearch and correct errors that can be corrected
oResubmit
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Error Codes
For the last quarter (July – Aug – Sept), the highest percentage of error codes were:
408 = 5.66%
409 = 5.23%
410 = 8.67%
408 – Service From Date is not within MA organization enrollment period.
409 – Service Through Date is not within MA organization enrollment period.
410 – Beneficiary is not enrolled in plan on or after Service From Date.
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Training Update
• Enrollment and Payment Training– October 30
• Risk Adjustment Training– October 31
October 2007 TrainingNow RegisteringNow Registering
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
*For detailed information
and to
register online
log on to
www.medicaretraining.net
2007/2008 Monthly Training Schedule*
Training Update
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
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2006/2007 Monthly
Risk Adjustment User Group Meeting
OC
TOBER
2007
A training
initiative
presented by
Resources
• Sean Creighton (Director, Division Risk Adjustment Operations)[email protected]
• Henry Thomas (Training, Project Officer) [email protected]
• Lateefah Hughes (Data Validation, Team Lead) [email protected]
• Louis Johnson (FERAS, Risk Adjustment Coordination) [email protected]
• Chanda McNeal (Payment Issues)[email protected]
• LTC www.Medicaretraining.net
• CSSC www.csscoperations.com