REGISTRATION FORM


Centers for Medicare & Medicaid ServicesRisk Adjustment Training
for Medicare+Choice Organizations

Las Vegas – June 3-4, 2002 ~ St. Louis – June 6-7, 2002
Philadelphia – June 10-11, 2002 ~ Orlando – June 13-14, 2002


Audience

This training is designed for Medicare+Choice (M+C) organization staff responsible for collection and submission of risk adjustment data, staff of organizations that are contracted by M+C organization to submit risk adjustment data on behalf of the M+C organization (third party), and M+C provider training staff.

Training Objectives

The primary objective of the training is to improve the quality and quantity of risk adjustment data. This training will also provide training tools for use by M+C organizations. The specific training objectives for participants are to understand:

  • Data requirements
  • Submission schedule
  • Coding requirements
  • Submission process
  • Risk score calculation
  • The new Risk Adjustment Processing System (RAPS)

Registration Information

Registration is required for admittance to this training. Please complete and return a registration form for each attendee.
CMS Contract Number: H-(4 digits) (If you are not affiliated with a M+C organization, then enter “9999”.
Organization Name:   
Type of Organization: 
(e.g., M+C organization, third party submitter, industry association, etc.)

IMPORTANT NOTE: Each training site is limited to 100 participants (Philadelphia-56 spaces). Registration for M+C organizations is limited to 2 attendees and is on a first come, first served basis. M+C organization staff will receive priority registration consideration due to training site limitations. Third party contractors that submit risk adjustment data on behalf of a M+C organization should attend this training and indicate this information above under “Type of Organization.”

Attendee Information

Last Name:

   First Name:  

Title:

Address:

City:

   State:     Zip: 

Telephone:

   Fax:  

Email Address:

Indicate Attendance Site (choose only one)

Las Vegas, Nevada Harrah’s Las Vegas Hotel & Casino June 3-4, 2002
St. Louis, Missouri Radisson Hotel & Suites St. Louis Downtown June 6-7, 2002
Philadelphia, Pennsylvania Crowne Plaza Philadelphia Center City June 10-11, 2002
Orlando, Florida Wyndham Orlando Resort June 13-14, 2002
You may submit this registration form electronically by choosing the “Submit Registration” button, or print the form and fax it to the contact person listed below.