Transcription of Medicare Advantage Risk Adjustment Data Validation …
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Medicare Advantage Risk Adjustment Data Validation …
Medicare Advantage Risk Adjustment data Validation (RADV) TrainingContract-Level Industry-Wide Training EventJanuary 29, 20191:00 2:30 , ET Welcome and IntroductionsCenter for Program Integrity (CPI) Alec Alexander Center DirectorGeorge Mills, Jr., Deputy DirectorJonathan Smith Program Manager (RADV Team)RADV Team Members Joanne Davis Larry Johnson Brenda M. JohnsonEsmail Essajee Evan Boyarsky Melissa Cooley Melissa HeestersGulnurFreemanDelois Newkirk Beth Schalm Mary B. Walker Martha Wagley2 Agenda Highlights3 Contract-Level RADV TerminologyTe r mDefinitionCYCalendarYe a rCON14 RADVCY 2014 Contract-Level RADVCMSC enters for Medicare & Medicaid ServicesC DATC entral data Abstraction ToolHCCH ierarchicalCondition CategoryINVI nvalid4Te r mDefinitionICD-9-CMInternational Classification of Diseases, Ninth Revision, Clinical ModificationICD-10-CMInternational Classification of Diseases, Tenth Revision, Clinical ModificationMAOM edicare Advantage OrganizationMRRM edical Record ReviewPHIP rotected Health InformationPIIP ers
Jan 29, 2019 · submitted from plans (risk score data can derive from plan submitted data and FFS claims data). – A specific beneficiary • Identify model (community, institutional, new enrollee, ESRD). • Identify risk factors within model which apply (one [1] or more). • Enrollee risk score = Sum of all relative and frailty factors. 17
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