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CMS issues rule on HHS risk adjustment data validation
11/25/2020

The CMS has announced a final rule to update the HHS risk adjustment data validation program with amendments to the error rate calculation methodology and how the HHS-RADV results are applied. The rule modifies how medical conditions within the same hierarchical condition category coefficient estimation groups are grouped to determine failure rates, among other changes, and it applies the HHS-RADV results to adjust the risk scores and transfer amounts for the benefit year being audited instead of for the subsequent benefit year, as was the previous practice.

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