by RISE
27. August 2010 18:18
It is so important to understand the Risk adjustment submission and payment cycle…and if you are anything like me, you will have to hear it over and over again before it really sinks in. In fact, I still get confused and have to say it out loud to my self sometimes. One suggestion is to keep a visual up to view at a glance because it can really seem complicated.
The time table is as follows:
|
Calendar Year
|
Dates of Service
|
Initial Submissions Deadline
|
First Payment
|
Final Submissions
|
Final Payment
|
|
2008
|
7/1/06-6/30/07
|
9/7/07
|
1/1/08
|
NA
|
NA
|
|
2008
|
1/1/07-12/31/07
|
3/7/08
|
7/1/08
|
1/31/09
|
8/09
|
|
2009
|
7/1/07-6/30/08
|
9/5/08
|
1/1/09
|
NA
|
NA
|
|
2009
|
1/1/08-12/31/08
|
3/6/09
|
7/1/09
|
1/31/10
|
8/10
|
|
2010
|
7/1/08-6/30/09
|
9/4/09
|
1/1/10
|
NA
|
NA
|
|
2010
|
1/1/09-12/31/09
|
3/5/10
|
3/5/10
|
1/31/11
|
8/11
|
It is critical that these dates are understood, not only by your risk adjustment area but by your entire organization. The payment cycle needs to be clearly articulated to your senior leadership team so that you are able to accurately set expectations when your are asking for funding for things like chart reviews, home assessments, additional FTE's, etc ... It is important to understand that the work you are doing today will not be reflected in your risk scores or your revenue today. As an example from the grid above: for 2009 dates of service, any submissions that CMS receives and accepts by the September sweeps deadline will be reflected in your January 2010 payment, however, you have until January 2011 to submit all of your 2009 dates of services and you will receive a final reconciliation for the 2009 dates of services in August of 2011. So there could be up to a two year lag in payment, depending on when a diagnosis is submitted and accepted by CMS.
You can also find a similar grid as well as other information related to risk adjustment out on the website.
Kimberly D. Stone, Director of Medicare Revenue Management, Government Programs Administration, PRESBYTERIAN HEALTHCARE SERVICES
