FIELD DESCRIPTIONS ON NEXT PAGE

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Figure 5M– RAPS Monthly Plan Activity Report Layout (continued)

Field No. Field Name Field Description

1 Report Name Name of the report as it appears in submitter’s mailbox. 2 Page Number Page number of the report. Six months arrayed per page. 3 Report Run Date Date CMS generated the report.

4 Report Full Name Full name of the report.

5 Service Year The year of the service through date.

6 Submitter ID Report is grouped by submitter identification number. A submitter may submit for more than one organization (H number).

7 Report Year and Date Month and year of the submission. 8

9

Plan Number Month

H number assigned by CMS; a different report is printed for each organization (H number).

The month of the service through date.

10 Total Submitted The total number of clusters submitted during the report period by the MA organization.

11 Total Rejected The total number of clusters submitted during the report period by the MA organization rejected due to errors.

12 Total Accepted The total number of clusters submitted during the report period by the MA organization accepted without errors.

13 Total Stored The total number of clusters submitted by the MA organization and accepted by RAPS during the report period, and stored in the database (does not include duplicates if identical clusters already stored in the database).

14 Total Model Stored The total number of required diagnosis clusters submitted by the MA organization and accepted by RAPS during the report period, and stored in the database.

15 Total Deletes Accepted The total number of deleted clusters submitted by the MA organization during the report period that were accepted with no errors.

16 Total Deletes Rejected The total number of deleted clusters submitted by the MA organization during the report period that were rejected with errors.

⌦

An MA organization’s management can determine how effectively it has submitted data by reviewing the number of clusters submitted and stored on a monthly basis. Figure 5N illustrates that the submissions for service year 2004 are going relatively well. There is an error rate of approximately three percent during the period identified on page 2 of the April 2004 report. The error rate is calculated by dividing the total records rejected into the total submitted; for example, April 2004 principal inpatient has 26 rejected out of 824 submitted, a three percent error rate. There is very little lag between the date of the visit or stay and the date those data were collected and submitted. For every inpatient principal diagnosis on

age 2 of the March 2004 report, there are four secondary diagnoses, which is appropriate. p

An area of concern may be the number of physician services. In the April 2004 report, no data for physicians were submitted with dates of service between July 2003 and December 2003. However, 350 clusters with dates of service between January 2004 and April 2004 were submitted. For all data with dates of service between January 2004 and April 2004, only seven percent of the data were from physicians. It is typical for about three-quarters of the data submitted to be from physicians, so this finding might be indicative of a problem. However, this may be explainable if the organization simply

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submitted its physician data before April 1 or after April 30, (i.e., the organization is submitting sufficie data, but did not send any physician data in April). Management should compare the data submitted during the previous month and take the

nt MA organization’s enrollment into account when interpreting this report a d resolving potential issues.

es of that ata and offering outreach or training to prevent this problem from occurring in the future.

n

During the month of April there was a group of clusters submitted for services performed in September 2003. One explanation for this could be difficulty collecting from particular providers. The error rate for the September 2003 data was 92 percent. Management should consider identifying the sourc

EDITS AND REPORTS

Figure 5N – RAPS Monthly Plan Activity Report

REPORT: RAPS0010 CMS RAPS ADMINISTRATION PAGE: 2 RUN DATE: 20040402 RAPS MONTHLY PLAN ACTIVITY REPORT SERVICE YEAR: 2003 SUBMITTER ID: SH7777 FOR THE MONTH OF MARCH, 2004

PLAN NO: H7777

PROVIDER TYPE/TOTALS JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL PRINCIPAL INPATIENT

TOTAL SUBMITTED 20915 17891 1739 1365 1721 2837 46468 TOTAL REJECTED 209 93 33 27 35 55 452 TOTAL ACCEPTED 20706 17798 1706 1338 1686 2782 46016 TOTAL STORED 20706 17798 1706 1338 1686 2782 46016 TOTAL MODEL STORED 17186 14772 599 455 573 946 34531 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0 OTHER INPATIENT TOTAL SUBMITTED 69458 47939 19020 14618 14264 20945 186244 TOTAL REJECTED 695 240 381 293 274 419 2302 TOTAL ACCEPTED 68763 47699 18639 14325 13990 20526 183942 TOTAL STORED 68763 47699 18639 14325 13990 20526 183942 TOTAL MODEL STORED 57073 39114 5965 4584 4285 6568 117589 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0 OUTPATIENT TOTAL SUBMITTED 60838 59543 11621 21381 23879 47758 225020 TOTAL REJECTED 61 30 175 321 359 717 1663 TOTAL ACCEPTED 60777 59513 11446 21060 23520 47041 223357 TOTAL STORED 60777 59513 11446 21060 23520 47041 223357 TOTAL MODEL STORED 50445 48801 3892 7161 7997 15994 134290 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0 PHYSICIAN TOTAL SUBMITTED 172301 101277 179713 173688 214495 129995 971469 TOTAL REJECTED 1723 1013 3595 3474 4290 2600 16695 TOTAL ACCEPTED 170578 100264 176118 170214 210205 127395 954774 TOTAL STORED 170578 100264 176118 170214 210205 127395 954774 TOTAL MODEL STORED 141580 83219 61642 59575 73572 44589 464177 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0

EDITS AND REPORTS

Figure 5N – RAPS Monthly Plan Activity Report (continued)

REPORT: RAPS0010 CMS RAPS ADMINISTRATION PAGE: 1 RUN DATE: 20040402 RAPS MONTHLY PLAN ACTIVITY REPORT SERVICE YEAR: 2004 SUBMITTER ID: SH7777 FOR THE MONTH OF MARCH, 2004

PLAN NO: H7777

PROVIDER TYPE/TOTALS JANUARY FEBRUARY MARCH APRIL MAY JUNE TOTAL PRINCIPAL INPATIENT

TOTAL SUBMITTED 1297 1301 293 0 0 0 2891 TOTAL REJECTED 26 26 0 0 0 0 52 TOTAL ACCEPTED 1261 1275 288 0 0 0 2824 TOTAL STORED 1235 1269 283 0 0 0 2787 TOTAL MODEL STORED 432 444 99 0 0 0 975 TOTAL DELE ACPTD 10 0 5 0 0 0 15 TOTAL DELE RJCTD 0 0 0 0 0 0 0 OTHER INPATIENT TOTAL SUBMITTED 8431 13489 411 0 0 0 22331 TOTAL REJECTED 169 270 3 0 0 0 442 TOTAL ACCEPTED 8262 13219 405 0 0 0 21886 TOTAL STORED 8261 13216 404 0 0 0 21881 TOTAL MODEL STORED 2891 4625 141 0 0 0 7657 TOTAL DELE ACPTD 0 0 1 0 0 0 1 TOTAL DELE RJCTD 0 0 2 0 0 0 2 OUTPATIENT TOTAL SUBMITTED 23415 17342 84 0 0 0 40841 TOTAL REJECTED 351 260 3 0 0 0 614 TOTAL ACCEPTED 23064 17081 81 0 0 0 40226 TOTAL STORED 20989 15199 77 0 0 0 36265 TOTAL MODEL STORED 7346 5320 27 0 0 0 12693 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 1 0 0 0 0 1 PHYSICIAN TOTAL SUBMITTED 111207 189171 0 0 0 0 300378 TOTAL REJECTED 2224 3783 0 0 0 0 6007 TOTAL ACCEPTED 108983 185388 0 0 0 0 294371 TOTAL STORED 108978 164995 0 0 0 0 273973 TOTAL MODEL STORED 38142 57748 0 0 0 0 95890 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0

EDITS AND REPORTS

Figure 5N – RAPS Monthly Plan Activity Report (continued)

REPORT: RAPS0010 CMS RAPS ADMINISTRATION PAGE: 2 RUN DATE: 20040503 RAPS MONTHLY PLAN ACTIVITY REPORT SERVICE YEAR: 2003 SUBMITTER ID: SH7777 FOR THE MONTH OF APRIL, 2004

PLAN NO: H7777

PROVIDER TYPE/TOTALS JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL PRINCIPAL INPATIENT

TOTAL SUBMITTED 0 0 74 0 0 0 74 TOTAL REJECTED 0 0 60 0 0 0 60 TOTAL ACCEPTED 0 0 14 0 0 0 14 TOTAL STORED 0 0 14 0 0 0 14 TOTAL MODEL STORED 0 0 6 0 0 0 6 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0 OTHER INPATIENT TOTAL SUBMITTED 0 0 296 0 0 0 296 TOTAL REJECTED 0 0 280 0 0 0 280 TOTAL ACCEPTED 0 0 16 0 0 0 16 TOTAL STORED 0 0 7 0 0 0 7 TOTAL MODEL STORED 0 0 2 0 0 0 2 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0 OUTPATIENT TOTAL SUBMITTED 0 0 0 0 0 0 0 TOTAL REJECTED 0 0 0 0 0 0 0 TOTAL ACCEPTED 0 0 0 0 0 0 0 TOTAL STORED 0 0 0 0 0 0 0 TOTAL MODEL STORED 0 0 0 0 0 0 0 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0 PHYSICIAN TOTAL SUBMITTED 0 0 0 0 0 0 0 TOTAL REJECTED 0 0 0 0 0 0 0 TOTAL ACCEPTED 0 0 0 0 0 0 0 TOTAL STORED 0 0 0 0 0 0 0 TOTAL MODEL STORED 0 0 0 0 0 0 0 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 0 0 0 0 0 0

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Figure 5N – RAPS Monthly Plan Activity Report (continued)

REPORT: RAPS0010 CMS RAPS ADMINISTRATION PAGE: 1 RUN DATE: 20040503 RAPS MONTHLY PLAN ACTIVITY REPORT SERVICE YEAR: 2004 SUBMITTER ID: SH7777 FOR THE MONTH OF APRIL, 2004

PLAN NO: H7777

PROVIDER TYPE/TOTALS JANUARY FEBRUARY MARCH APRIL MAY JUNE TOTAL PRINCIPAL INPATIENT

TOTAL SUBMITTED 100 435 200 89 0 0 824 TOTAL REJECTED 0 4 20 2 0 0 26 TOTAL ACCEPTED 100 429 180 87 0 0 796 TOTAL STORED 90 420 180 80 0 0 770 TOTAL MODEL STORED 30 152 52 26 0 0 260 TOTAL DELE ACPTD 0 2 0 0 0 0 2 TOTAL DELE RJCTD 0 0 0 0 0 0 0 OTHER INPATIENT TOTAL SUBMITTED 400 1740 696 348 0 0 3184 TOTAL REJECTED 12 52 21 10 0 0 95 TOTAL ACCEPTED 388 1688 666 338 0 0 3080 TOTAL STORED 386 1668 661 333 0 0 3048 TOTAL MODEL STORED 135 583 232 117 0 0 1067 TOTAL DELE ACPTD 0 0 2 0 0 0 2 TOTAL DELE RJCTD 0 0 7 0 0 0 7 OUTPATIENT TOTAL SUBMITTED 0 377 252 0 0 0 629 TOTAL REJECTED 0 10 8 0 0 0 18 TOTAL ACCEPTED 0 362 244 0 0 0 606 TOTAL STORED 0 350 231 0 0 0 581 TOTAL MODEL STORED 0 123 80 0 0 0 203 TOTAL DELE ACPTD 0 0 0 0 0 0 0 TOTAL DELE RJCTD 0 5 0 0 0 0 5 PHYSICIAN TOTAL SUBMITTED 308 40 0 0 0 0 350 TOTAL REJECTED 9 4 0 0 0 0 13 TOTAL ACCEPTED 299 36 0 0 0 0 335 TOTAL STORED 284 36 0 0 0 0 320 TOTAL MODEL STORED 99 13 0 0 0 0 112 TOTAL DELE ACPTD 2 0 0 0 0 0 2 TOTAL DELE RJCTD 0 0 0 0 0 0 0

EDITS AND REPORTS

5.5.2 RAPS Cumulative Plan Activity Report

The RAPS Cumulative Plan Activity Report provides a cumulative summary of the status of submissions. The report is arrayed by provider type and month (determined by through date of service), and reports information by submitter ID and H number. Figure 5O illustrates the report and its fields.

The Cumulative Plan Activity Report is delivered to users on the second business day of each month.

Figure 5O – RAPS Cumulative Plan Activity Report Layout

[1]REPORT: RAPS0010 CMS RAPS ADMINISTRATION [2]PAGE: 2

[3]RUN REPORT: DATE: 20040503 [4] RAPS CUMULATIVE PLAN ACTIVITY REPORT [5]SERVICE YEAR: 2003