Risk Adjustment 101/Encounter Data 101

Risk Adjustment 101/Encounter Data 101

 
Schedule
SessionDateTime
Security Risk Nov 1, 2013 10:00 a.m. - 3:00 p.m. ET
Enrollment TBD TBD
Risk Adjustment 101 July 23, 2013 10:00 a.m. – 12:00 p.m. ET
Encounter Data 101 July 29, 2013 11:00 a.m. – 1:00 p.m. ET
Security Risk Session Details
Purpose
The Enrollment session will provide Medicare Advantage (MA) organizations, Prescription Drug Plans, and other Medicare health plans with information and resources that will simplify and clarify the terminology, processes, and changes in enrollment. By providing enrollment and disenrollment guidelines, CMS ultimately encourages accurate processing.
 
Recommended Audience
The recommended audience from the following organization types should find this session useful:
  • Medicare Advantage (MA) Organizations
  • Other Medicare Health Plans (PACE, Cost Plans, etc.)
  • Standalone Prescription Drug Plans (PDPs)
  • Enrollment Vendors and Third Party Submitters
  • Industry Associations
This session is intended for staff in the following roles or departments responsible for the information covered in this session:
  • Enrollment Specialist
  • Operations
  • Information Technology (IT)
Registration Details

A maximum of two (2) attendees per CMS Contract ID. The initial registrant will be approved and any additional registration requests will be approved based on availability.
Duration
This session will run for approximately four (4) hours. The Technical Assistance session will begin at 12:00 PM (ET), and will conclude at 4:00 PM (ET).
 
Module Topics & Descriptions
Icon Enrollment Data Validation and Quality Review
This session will focus on the process and experience of the CMS data validation activities, including the RPC Quality Review. The group will explore areas of concern and look to share best practices. The group will review examples of Quality Review responses and learn to identify successful versus unsuccessful submissions.
Icon e-RPT Refresher and Upcoming Enhancements
This module will provide a refresher on the use of the Electronic Retroactive Processing Transmission (eRPT) application. It will detail the requirements for each type of submission package plans can send to the Retroactive Processing Contractor (RPC) as well as response documents provided by the RPC. There will also be an overview of enhancements planned for a future release.
Icon End of Year Process
This session will provide an in-depth review of the processes that occur annually, as well as the associated timeline. Participants will gain a better understanding of their role with the re-deeming, reassignment, and rollover process.
Icon Number of Uncovered Months
Participants in this session will review policies and procedures that address computing and reporting the Number of Uncovered Months for application of the Part D Late Enrollment Penalty.
Icon Cancellations, Reinstatements, and Retroactive Enrollments
This session will review policies and procedures that address the differences between enrollment actions. Participants will gain a better understanding of their role with processing cancellation, reinstatement, and retroactive enrollment actions.
Icon Common Enrollment Issues
This session will review a variety of topics for which plans frequently request clarification. Participants will gain a better understanding of election periods and enrollment processes related to Employer Group Health Plans and hierarchy of election periods.
 
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Enrollment Session Details
Purpose
The Enrollment session will provide Medicare Advantage (MA) organizations, Prescription Drug Plans, and other Medicare health plans with information and resources that will simplify and clarify the terminology, processes, and changes in enrollment. By providing enrollment and disenrollment guidelines, CMS ultimately encourages accurate processing.
 
Recommended Audience
The recommended audience from the following organization types should find this session useful:
  • Medicare Advantage (MA) Organizations
  • Other Medicare Health Plans (PACE, Cost Plans, etc.)
  • Standalone Prescription Drug Plans (PDPs)
  • Enrollment Vendors and Third Party Submitters
  • Industry Associations
This session is intended for staff in the following roles or departments responsible for the information covered in this session:
  • Enrollment Specialist
  • Operations
  • Information Technology (IT)
Registration Details
A maximum of two (2) attendees per CMS Contract ID. The initial registrant will be approved and any additional registration requests will be approved based on availability.
Duration
This session will run for approximately four (4) hours. The Technical Assistance session will begin at 12:00 PM (ET), and will conclude at 4:00 PM (ET).
 
Module Topics & Descriptions
Icon Enrollment Data Validation and Quality Review
This session will focus on the process and experience of the CMS data validation activities, including the RPC Quality Review. The group will explore areas of concern and look to share best practices. The group will review examples of Quality Review responses and learn to identify successful versus unsuccessful submissions.
Icon e-RPT Refresher and Upcoming Enhancements
This module will provide a refresher on the use of the Electronic Retroactive Processing Transmission (eRPT) application. It will detail the requirements for each type of submission package plans can send to the Retroactive Processing Contractor (RPC) as well as response documents provided by the RPC. There will also be an overview of enhancements planned for a future release.
Icon End of Year Process
This session will provide an in-depth review of the processes that occur annually, as well as the associated timeline. Participants will gain a better understanding of their role with the re-deeming, reassignment, and rollover process.
Icon Number of Uncovered Months
Participants in this session will review policies and procedures that address computing and reporting the Number of Uncovered Months for application of the Part D Late Enrollment Penalty.
Icon Cancellations, Reinstatements, and Retroactive Enrollments
This session will review policies and procedures that address the differences between enrollment actions. Participants will gain a better understanding of their role with processing cancellation, reinstatement, and retroactive enrollment actions.
Icon Common Enrollment Issues
This session will review a variety of topics for which plans frequently request clarification. Participants will gain a better understanding of election periods and enrollment processes related to Employer Group Health Plans and hierarchy of election periods.
 
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Risk Adjustment 101 Session Details
Purpose
Risk Adjustment Technical Assistance will provide participants with information and resources related to risk adjustment policies, operations, and risk score calculations. The Risk Adjustment 101 session will provide an introduction and overview of this process and serve as a foundation for more detailed National Technical Assistance.
 
Recommended Audience
This session is intended for new staff members or new Medicare Advantage Organizations who need an overview of the Risk Adjustment process. Roles include:
  • IT
  • Operations Staff
  • Risk Adjustment/Encounter Data Staff
  • Compliance Officer
  • Quality Assurance/Quality Control Staff
  • Payment Reconciliation Specialist
  • Finance/Revenue Staff
  • Coder/Data Analyst
  • Chief Executive Officer
  • Consultant
  • Auditor
  • Third Party Submitter (TPS)
  • Industry Association Representative
Registration Details
Registration is required, and a maximum of two (2) registrants per CMS contract can attend the session. The initial registrant will be approved and any additional registration requests will be approved based on availability. This session is not recommended for Standalone PDPs. The recommended audience from the following organization types should find this session useful:
  • Medicare Advantage (MA) Organizations
  • Medicare Advantage–Prescription Drug (MA-PD) Plans
  • Third Party Submitters
  • Industry Associations
Duration
This session will be delivered as a live webcast and will run for two (2) consecutive hours.
 
Module Topics & Descriptions
IconRisk Adjustment Overview
This module provides an introduction and overview of Risk Adjustment.
IconConnectivity and Testing
This module provides the process for connecting to and testing the Risk Adjustment Processing System.
IconKey Data Elements of Risk Adjustment
This module provides a high-level overview of the types of required data.
IconKey Data Elements of Risk Adjustment
This module provides a high-level overview of the types of required data.
IconThe Risk Adjustment Processing System (RAPS)
This section provides an understanding of what the Risk Adjustment Processing System is, the format for submitting Risk Adjustment data, how the data flows through this system, and the timeline for RAPS submissions.
IconReports
This module provides a high-level overview of the Front-End Risk Adjustment System (FERAS) and the CMS Risk Adjustment Processing System (RAPS) data logic and editing processes. It also describes the reports used by plans for Risk Adjustment, and explains how and when to access these reports.
IconRisk Adjustment Resources
This module provides essential terms, key resources, and important links to ensure a foundation for understanding Risk Adjustment.
 
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Encounter Data 101 Session Details
Purpose
The purpose of this webcast is to provide participants with a basic understanding of the Encounter Data System and the resources necessary to prepare for the collection and submission of encounter data.
 
Recommended Audience
This session is intended for new staff members or new Medicare Advantage Organizations who need an overview of the Risk Adjustment process. Roles include:
  • IT
  • Operations Staff
  • Risk Adjustment/Encounter Data Staff
  • Compliance Officer
  • Quality Assurance/Quality Control Staff
  • Payment Reconciliation Specialist
  • Finance/Revenue Staff
  • Coder/Data Analyst
  • Chief Executive Officer
  • Consultant
  • Auditor
  • Third Party Submitter (TPS)
  • Industry Association Representative
Registration Details
Registration is required, and a maximum of two (2) registrants per CMS contract can attend the session. The initial registrant will be approved and any additional registration requests will be approved based on availability. This session is not recommended for Standalone PDPs. The recommended audience from the following organization types should find this session useful:
  • Medicare Advantage (MA) Organizations
  • Medicare Advantage–Prescription Drug (MA-PD) Plans
  • Third Party Submitters
  • Industry Associations
Duration
This session will be delivered as a live webcast and will run for two (2) consecutive hours.
 
Module Topics & Descriptions
Icon Introduction
This module will provide the purpose and overview of the encounter data system.
Icon Overview
This module will provide an overview of the technical requirements and resources available for the submission of encounter data files.
Icon Submission Requirements
This module will provide a high-level overview of the types of encounter data submissions, differences between each of the subsystems, and how to submit encounters for each file type.
Icon EDS Reports
This module describes the purpose for EDFES reports and EDPS reports and how to review and reconcile the reports for successful encounter data submissions.
Icon Best Practices
This module provides best practices for the successful submission of encounter data.
 
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Registration
Registration Closed