Bad data validation scores reduce your star rating and bottom line

By Chris Hanson-Ehlinger
Wed, Aug, 13, 2014
Data validation auditBad data validation findings can chip away at your star rating. The 2015 Medicare Advantage call letter highlighted four themes: bid review, decreasing costs, promoting creative benefit designs and improving beneficiary protections. Let’s look at one theme, beneficiary protections, to see how a bad data validation score could impact your plan’s star rating.

New stars

Per last year’s call letter, CMS added SNP reporting to 2015 star ratings (using data reported for 2013). If your plan did not score a 95 percent or higher on data validation when reporting the SNP care management section (as validated in June 2014’s data validation cycle), then CMS will show the phrase “CMS identified issues with this plan’s data” instead of publishing the SNP measure’s data. That translates into a 1-star score for the specific measure and drags down your overall star rating, with potentially significant financial implications. It’s too late to change your score this year but you can prepare your plan to improve next year’s SNP reporting section.

Stars on deck

CMS star rating process includes other measures that also undergo data validation: grievance rates and MTMP CMR completion rates. These measures do not contribute to star ratings yet (CMS calls them “display measures”) but CMS may begin incorporating them into star ratings in the future. In fact, CMS already indicated 2016 star ratings will include MTMP. For plans that achieved less than 95 percent on grievances or MTMP in data validation, CMS is notifying plans in writing that the display measure scores would be 1 star if they were incorporated into star ratings.

Protect your stars

Start planning for 2015 now. We cannot emphasize—or repeat—frequently enough the need to plan ahead for each data validation cycle. Planning early ensures you’re better prepared for the February 28 reporting deadline and helps avoid last minute mistakes and oversights.

CMS data validation audit, CMS data validation pre-assessment

Other related articles:

Poor scores posted for 2013 data validation SNP reporting

Align data validation stakeholders to avoid last minute mistakes

Complex CMS changes may cut into your data validation score
 

Derek Frye, The Burchfield GroupDerek Frye, CISA, leads the data validation and commercial audit teams at The  Burchfield Group and has conducted dozens of data validation pre-assessments and  audits. For more information, please call 800-778-1359 or send us a note (http://www.burchfieldgroup.com/contact/).

Copyright © 2014 The Burchfield Group. All rights reserved. No part of the content contained herein may be transmitted, redistributed, copied, stored, downloaded, abstracted, disseminated, circulated or included as part of any other service or product. For all permissions, please contact chanson-ehlinger@burchfieldgroup.com

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