Risk Adjustment

CMS Announcements: RAPS Submissions of Data Collection Year Diagnosis Codes

In June 20, 2017, the Centers for Medicare and Medicaid Services released a letter directed to all Medicare Advantage organizations, PACE organizations, and Medicare/Medicaid plans to address the issue of when beneficiaries are enrolled in a plan with a different parent organization during the data collection period than in the payment year.

CMS is aware of the challenges plans faced when enrolling members coming from a different parent organization, and the impact in diagnoses captured. In order to ease this particular challenge, CMS is specifying that organizations are able to submit diagnoses codes to RAPS for years when a member was enrolled in a plan with different parent organization (but not if the member was in Fee-for-Service Medicare the year before).

This is a new resource for plans to capture pending diagnoses for new members with low risk scores.


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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider