Risk Adjustment for EDS and RAPS User Group - May 28, 2020

Risk Adjustment for EDS and RAPS User Group - May 28, 2020

Table of Contents

• Slides 14-19 - Risk Adjustment Model Overview, Model updates, Finalized PY2021 risk adjustment models
• Slides 22-31 - Risk Score Calculation, Overview, Process for payment year 2021, including example and adjustments to risk scores
• Slides 33, 41-43 - Telehealth Services, HPMS Memo on Best Practices, Telehealth diagnoses meet the risk adjustment face-to-face requirement, as noted in April 10, 2020 HPMS memo
• Slide 34 - Frailty Score Calculation, 2020 HOS & HOS-M Surveys, Survey will be delayed in Response to the COVID-19 PublicHealth Emergency (PHE) Interim Final Rule
• Slide 37 - RAPS Edits, Edit 408, 409, 410 correction, HPMS Memo regarding identification of issues with 408/409/410 RAPS edits
• Slide 38 - NPI Registry, NPPES system, CMS developed the NPPES system to assign NPI
• Slide 39 - EDPS Edits, Preclusion List edits 01440, 01445, 01445, 01455, March 19, 2020 HPMS memo introduces preclusion list edits
• Slide 40 - EDPS Edits, Edit 00860, March 19, 2020 HPMS memo explains Edit 00860 – Replacement for CRR-Delete Not Allowed
• Slide 40 - EDPS Edits, Edit 25015, March 19, 2020 HPMS memo explains Edit 25015 is updated to bypass on Chart Review submissions
• Slide 44 - CMS-HCC Model Risk Score Calculation, Rounding & Risk score Calculation for PY2018 and PY2019, Correction to technical rounding issue
• Slide 45 - RAPS Edits, Edit 503, Overview
• Slide 47 - CMS-HCC Model Risk Score Calculation, Dementia, 2020 CMS-HCC model includes HCCs for dementia
• Slide 49 - PACE Organizations, Identifying frailty, Frailty score information is posted in HPMS
• Slide 50 - Risk Adjustment Model Overview, Relative factors, Relative factors for the models being used in payment for 2021