Risk Adjustment for EDS and RAPS User Group - December 19, 2019

Risk Adjustment for EDS and RAPS User Group - December 19, 2019

Table of Contents

• Slide 13 - EDPS Edits, Edit 00805, Changes to edits announced in September 5, 2019 HPMS memo
• Slide 14 - EDPS Edits, Edit 25010 and 27005 Informational edits, Edit 25010 Modifier Invalid for DOS and Edit 27005 Non-ESRD HCPCS for ESRD PPS Encounter implemented on September 27, 2019
• Slides 16-17 - MBI Implementation, RASS MBI Related Changes ; Edit 500, Updating Edit 500 relating to MBI
• Slides 19-20 - EDS Submission, Submission of Partially Capitated Encounters, Update to Encounter Data Submission and Processing Guide on partially capitated encounters
• Slides 22-23 - HIPPS Codes for SNF and HHA EDRs, Legacy and new HIPPS codes, September 26, 2019 HPMS Memo on HIPPS codes
• Slides 25-29 - Risk Adjustment Model Overview, Model updates, PY 2020 overview of risk adjustment models
• Slide 30 - EDS Submission, Submission deadlines
• Slides 33-35 - MOR, MOR Updates by model, Updates including blended risk score, data source and plan communications user guide
• Slide 37 - EDFES, Type of Bill (TOB), Reference data updated to include Type of Bill (TOB) 73X
• Slide 38 - EDFES, DNR Condition Code, Use of DNR Condition Code = P1
• Slide 40 - Risk Adjustment Data Submission, Edit 502, Addressing duplicate diagnoses
• Slide 42 - MAO-002, Rejections at line level, Header vs Line rejection
• Slide 43 - Chart Review Record Submissions, E Code, Deleting an E Code where E Code is in the primary diagnosis position
• Slide 44 - EDFES Edits, Edit 255, Determining highest level of specificity
• Slide 45 - Supplemental Services, Dental Services, Submitting for dental services
• Slide 46 - Supplemental Services, Gym Memberships, Plans determine codes for supplemental services
• Slide 47 - MOR, MBI vs HICN, For 2019 final reconciliation, MORs will include updates to replace the HICN field with MBIs