Upcoming HCC season will delay
The Centers for Medicare & Medicaid Services (CMS) informed all Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid plans, and programs that fall under the All-Inclusive Care for the Elderly (PACE) organizations that it is reprioritizing the audit activity due to the spread of the virus.
The March 30 memo stated that CMS would suspend Risk Adjustment Data Validation (RADV) audit activities related to the payment year 2015 and won’t initiate any additional contract-level audits until after the public health emergency is over. The suspension takes effect immediately.
As a result, organizations must immediately suspend requests for RADV-related medical records from providers.
However, organizations may submit to CMS any medical record documentation that it has already obtained because the Central Data Abstraction Tool will remain open. The agency will also keep the RADV mailbox and CDAT help desk open.
CMS will continue to review submitted medical records, including submissions for the 2014 audit, and will provide feedback to organizations through CDAT.
The suspension will be lifted once the public health emergency has ended. CMS will make an announcement when it plans to resume normal audit activities.
For more information or questions about contract-level RADV audits, CMS asks that organizations send an email to RADV@cms.hhs.gov.