July 2010 - CSSC Operations

Report
2009/ 2010 Monthly
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Risk Adjustment
User Group
July 2010
Welcome to the July
User Group
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2010
Introduction
Payment Process
Data Validation
Operations Update
Questions and Answers
Closing
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Introduction
2010
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INTRODUCTION
2010
User Group Process
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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
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INTRODUCTION
2010
• The 2010 monthly Risk Adjustment
User Group dates are posted on the
CSSC Operations website.
www.csscoperations.com/new/usergroup/usergroupinfo.html
• Please continue to review the
website for updates to this
information.
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INTRODUCTION
2010
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:
– [email protected] for Payment
Operations
– [email protected] for Data Validation
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Payment Process
2010
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PAYMENT PROCESS
2010
• Response Rate:
• 100% resolved in April 2010
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90% resolved in May 2010
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95% resolved in June 2010
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PAYMENT PROCESS
2010
• Highlights:
• Update on implementation of ICD-10 diagnosis
codes;
• The final 2009 reconciliation update is
scheduled for the August payments;
• Plans should see the appropriate adjustments
for part c and d under:
– ARC 25 FOR Part C
– ARC 37 FOR Part D
• The rerun for Payment Years 2006, 2007,
2008 is scheduled for the August payments
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PAYMENT PROCESS
2010
Question –
Please explain what information is
provided on the HCC Model Output
Report (MOR). Do the reports reflect
only the diagnoses submitted during
the prior month or are they
cumulative?
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Data Validation
2010
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DATA VALIDATION
2010
• CY 2007 Targeted Sample
• CY 2008 National Sample
• CY 2008 Contract – Level Sample
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DATA VALIDATION
2010
• CY 2007 Targeted Sample
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Intake Technical Assistance Report: will soon be released
• The Intake TA Report will identify inconsistencies in date of service
and/or provider type as well as other inconsistencies (e.g.,
obscured text).
• CMS will hold a teleconference to coincide with the distribution of
Intake TA Reports
– CMS will discuss:
» Format of the report
» Time period and requirements for plan response
» Importance of reviewing and reporting any issues to the
IMRRC
– Date, time, and dial-in information will be forthcoming.
• Intake TA Reports and teleconference information will be sent by
the IMRRC (Healthcare Management Solutions) via email to CY
2007 Targeted Sample plan-designated contacts.
• A Medical Record Receipt Report will also be included with the
Intake TA Report.
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DATA VALIDATION
2010
• CY 2007 Targeted Sample Contact
Confirmation
– This request was sent to previously-confirmed contacts and the
CEO for each plan in the sample. The IMRRC has received
responses from all plans. Thank you for your prompt response
to this request.
– Adding or changing contact information for the CY 2007
Targeted Sample does not update your plan’s information
in the HPMS system.
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DATA VALIDATION
2010
• CY 2008 National Sample
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
Medical record review has been completed, CMS is currently
analyzing results
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DATA VALIDATION
2010
CY 2008 Contract-Level Sample
• MA organizations (MAOs) selected for this sample
will be notified
• Notification will be sent to MAO CEO and MCO
• Training will be provided—
o In-person at CMS, and
o Via Webinar
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DATA VALIDATION
2010
• RADV Mailbox – [email protected]
– MAOs may submit RADV questions to
this mailbox
– Questions will be reviewed by the RADV
team and answered via this mailbox
– Several questions have been received,
CMS is working on issuing individual
responses
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Operations Updates
2010
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Operations
2010
Reasons to Delete Diagnosis Cluster
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Diagnosis cluster submitted erroneously (e.g.,
data from an interim bill was submitted for hospital
inpatient, type of bill 112 / 113. When TOB 114 has
been received, correct previously submitted claim
with the correct diagnosis clusters.
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Incorrect HIC number used for submission on a
beneficiary’s claims.
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An error in a diagnosis cluster field (i.e., “Provider
Type,” “Dates of Service,” “Diagnosis Code”).
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Operations
2010
Method 1 for Deleting Clusters
1.Submit RAPS format using normal submission
process with appropriate HIC number included.
2.Enter information in the diagnosis cluster fields (9.0,
9.1, 9.2, 9.4, 9.5) exactly as it appeared in the original
submission.
3.In field 9.3 enter a “D” for delete.
4.Enter the appropriate information in all other
records to ensure the submission file is complete.
5.Transmit the file to FERAS. (See
www.csscoperations.com for details.)
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Operations
2010
Method 2 for Deleting Clusters:
1.
Create a file using the Direct Data Entry (DDE) screens
available through FERAS at Palmetto
2.
Enter information exactly as it appeared in the original
submission.
3.
In the DDE “CCC” record screen, hit the down arrow key
and select “D.”
4.
Proceed with entering all appropriate information.
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5. Upload the file created in DDE to FERAS at Palmetto.
Technical Assistance
Updates
2010
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Questions & Answers
2010
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Closing
2010
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RESOURCES
2010
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Sean Creighton (Director, Division of Risk Adjustment & Payment
Policy) [email protected]
Henry Thomas (Training, Project Officer)
[email protected]
Louis Johnson (FERAS,GTL) [email protected]
Chanda McNeal (RAS Payment) [email protected]
Jennifer Harlow (RADV) [email protected]
Lateefah Hughes (RADV) [email protected]
Carolyn Kapustij [email protected]
Payment Research [email protected]
RADV Questions [email protected]
CSSC www.csscoperations.com
LTC www.tarsc.info
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