Risk Adjustment for EDS and RAPS User Group - February 20, 2020
Risk Adjustment for EDS and RAPS User Group - February 20, 2020
Table of Contents
- Slide 15 - EDS Submission, Submission Date stamp in ICN, Correcting issue with using date embedded in ICN
- Slides 19-22 - Risk Adjustment Data Submission, Overview, History from 1997-2001
- Slide 23 - Risk Adjustment Data Submission, Overview, Flow charts for EDS & RAPS processing
- Slides 26-28 - Risk Adjustment Data Submission, Overview, Purpose, structure, and example
- Slide 29 - Risk Adjustment Model Overview, Model descriptions for PACE, Part C, Part D, ESRD
- Slide 30 - PACE Organizations, Risk score calculation, Pool diagnoses from encounter data, RAPS and FFS claims
- Slides 31-32 - PACE Organizations, Medicaid Status Data File, How to identify Medicaid status when calculating risk scores
- Slides 34-37 - PACE Organizations, Identifying frailty, Overview of the frailty payment
- Slides 39-40 - MOR, PACE Organizations, MOR for PACE organizations
- Slides 41-43 - MMR, Source of enrollment and demographic data, Status indicators including Medicaid dual status code
- Slides 45-53 - PACE Organizations, Risk score calculation, Risk score calculation for PACE organizations
- Slide 55 - PACE Organizations, Identifying frailty, Requirements of calculating frailty payment; HOS-M
- Slide 56 - PACE Organizations, PACE capitation payment, Calculating the monthly capitation rate
Last Updated: 02/20/2020