Risk Adjustment

CMS Extends 2016 DOS Deadline for RAPS Submissions

In the January 26th memo regarding Risk Adjustment data deadlines, the Centers for Medicare & Medicaid Services (CMS) extended the 2017 (2016 DOS) Final Reconciliation deadline for RAPS submissions to May 4, 2018.

The Interim Final Reconciliation deadline for PY2017 is still Jan. 31st 2018. Per the memo dated Dec. 20, 2017, CMS will announce the PY2017 Final Reconciliation deadline for encounter data soon.

The extension is due to extreme weather events, which impacted risk adjustment data collection and submission efforts. A three-month opportunity now exists for health plans to revisit 2016 DOS RAPS submissions, providing the chance to ensure both revenue integrity and coding-results accuracy.

Capture Missing HCCs

Payers can now confirm that all value has been recovered by looking for HCCs that haven’t yet been submitted or captured. Though plans were preparing for a January 31st submission, this opportunity allows payers to look deeper into member data to recover missed HCC opportunities. To be the most effective, payers need the analytical capabilities to identify and prioritize members or providers with the highest opportunities.

Episource is offering all health plans a free trial of epiAnalyst from now until April 1st to take a deeper look at member data and ensure all HCC opportunities are identified.

Ensure RAPS Data Submission Accuracy

For health plans that need iron-clad confidence in their coding results, payers now have the chance to verify their intended submission through a Coding Audit. Three months isn’t too short to verify the results of a coding project and confirm that no HCCs were missed in the original chart review.

Last April, Episource found nearly 45,000 new HCC additions during a two-week Coding Audit on more than 80,000 charts.

Reconcile and Fix Remaining Errors in RAPS-EDPS Data

While the recent memo has provided an opportunity to double-check RAPS submissions, health plans should also keep their eye on the larger end-goal: effective error-management systems. No matter what system a health plan uses, whether home-grown or a vendor’s, the number one consideration when it comes to encounter data is workflow. To that end, an automated process is a must-have for an efficient risk adjustment program.

With time to verify current submissions, run a chart audit, or assess RAPS-EDPS data errors, payers now have a window of opportunity that they can’t afford to miss. Episource delivers each of the above services and can ensure integrity and accuracy in time for the May 4th deadline.


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