Frequently Asked Question (FAQ)


FAQ ID:  1405 Publish Date: 04/14/2014
* 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:

Is there a crosswalk that compares the Risk Adjustment and Data Validation (RADV) methodology that the Department of Health and Human Services (HHS) runs on behalf of State based Marketplaces (SBMs) to the Medicare RADV methodology?

Answer:

CMS does not have a common crosswalk that compares these two programs. Both programs adopt similar methods regarding the sampling concepts and methods that require implementation of national acceptable standards for review of enrollee health conditions to validate payment accuracy. However, HHS-operated RADV program differs in that our methods for assessing payment accuracy are driven primarily by principles that underlie our risk adjustment payment transfer methodology, which is not a payment concept for the MA program.


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