2006/2007 monthly

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2006/2007 Monthly

Risk Adjustment User Group Meeting

OC

TOBER

2007

A training

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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

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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

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2007

A training

initiative

presented by

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2006/2007 Monthly

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2007

A training

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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

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TOBER

2007

A training

initiative

presented by

6

2006/2007 Monthly

Risk Adjustment User Group Meeting

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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

7

2006/2007 Monthly

Risk Adjustment User Group Meeting

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TOBER

2007

A training

initiative

presented by

8

2006/2007 Monthly

Risk Adjustment User Group Meeting

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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

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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

10

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

11

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

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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

13

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.

14

2006/2007 Monthly

Risk Adjustment User Group Meeting

OC

TOBER

2007

A training

initiative

presented by

15

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

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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

17

2006/2007 Monthly

Risk Adjustment User Group Meeting

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TOBER

2007

A training

initiative

presented by

18

2006/2007 Monthly

Risk Adjustment User Group Meeting

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TOBER

2007

A training

initiative

presented by

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2006/2007 Monthly

Risk Adjustment User Group Meeting

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TOBER

2007

A training

initiative

presented by

Resources

• Sean Creighton (Director, Division Risk Adjustment Operations)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

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

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

• LTC www.Medicaretraining.net

• CSSC www.csscoperations.com