Frequently Asked Question (FAQ)


FAQ ID:  11290a Publish Date: 03/07/2016
* Retired FAQ
Retired Date:  04/15/2019

* Retired FAQ - FAQ for which policy may have changed or been updated. FAQ is available for informational purposes only in order to provide historical program knowledge. Not intended to provide current guidance or policy.

Program Area:

HHS Risk Adjustment Data Validation (HHS-RADV)

Primary Category:

General Audit Standards (IVA-SVA)

Secondary Category:

Other

Question:

When will the HHS-Operated Risk Adjustment Data Validation program (HHS-RADV) begin?

Answer:

In the HHS Notice of Benefit and Payment Parameters for 2014 (78 FR 15410), CMS stated that in conducting the HHS-RADV program, it would adjust Risk Adjustment (RA) payments and charges based on the results of the HHS-RADV program in 2018 for 2016 benefit year data. CMS explained that issuers and auditors would have two (2) preliminary years in which to implement and test the HHS-RADV program, and adjust their audit procedures in response to that experience. RA payments and charges will continue to be adjusted in 2018 for 2016 benefit year data, in keeping with the original schedule.

However, CMS will not conduct HHS-RADV on 2014 data, originally one (1) of two (2) preliminary testing years. CMS will still conduct HHS-RADV in 2016 for 2015 benefit year data - thus, issuers and auditors will have one (1) preliminary testing year instead of two (2) in which to implement and test the HHS-RADV program, and adjust their audit procedures in response.


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