A Step-by-Step Guide for 2024 CMS Risk Adjustment Submission Deadlines

CMS Risk Adjustment

Ensuring proper reimbursement for Medicare Advantage Organizations (MAOs), PACE organizations, and other Medicare programs is not a matter of chance; it is a result of diligent efforts. Timely and accurate submission of risk adjustment data is crucial. This data reflects the health status of your members, directly impacting the risk scores that determine your plan’s payments. Failing to submit CMS risk adjustments before the deadline could result in significant financial challenges that may jeopardize your organization’s financial stability.

This comprehensive guide serves as a roadmap for navigating the CMS risk adjustment submission deadlines 2024 process and ensuring you don’t miss a beat.

Understanding Risk Adjustment and Deadlines

The risk adjustment method considers the various health requirements of distinct enrollee populations. To illustrate the complexity of their patient population, MAOs submit diagnoses and other health data. After computing risk scores using this data, Medicare reimburses the plan for each enrollee’s amount.

For every payment year, the Centers for Medicare & Medicaid Services (CMS) set forth dates for the submission of risk adjustment data. Usually published in the early spring, these deadlines pertain to three submission windows:

  • Initial Data Submission: This is the first opportunity to submit data for the year.
  • Mid-Year Data Submission: This window allows for capturing additional diagnoses and updates to existing data.
  • Final Reconciliation Run: This is the final chance to submit any missing or corrected data and serves as a chance to reconcile any discrepancies.

Why Deadlines Matter

For several reasons, it is essential to file CMS risk adjustments by the deadline:

  • Data Accuracy: You can ensure that your risk scores are accurate by submitting your work ahead of time. This will give you plenty of time to identify and correct any errors or missing data points.
  • Audit Readiness: A streamlined filing procedure with unambiguous documentation facilitates future CMS audits.
  • Financial Reimbursement: Late submissions may result in fewer reimbursements since they may not be considered in determining the risk score for the current year.

A Step-by-Step Guide to 2025 CMS Risk Adjustment Deadlines

1. Stay Informed: Bookmark Key Resources

  • CMS Deadlines Document: Save the official CMS documents, which include deadlines for risk adjustments and highlight important dates for the upcoming year. They update this document every year, so check regularly to see the CMS risk adjustment submission deadlines 2024.
  • Extra Resources for CMS: Learn about Medicare Risk Adjustment via CMS’s resources, including FAQs and program manuals. These resources offer comprehensive instructions for gathering, submitting, and validating data.

2. Develop a Submission Calendar

Ensure your company has a clear internal schedule once the 2025 deadlines are available. The following should be on this calendar:

  • Deadline for Initial Data Submission: This usually falls early in the year. By this date, all MAOs must report comprehensive risk adjustment data.
  • Mid-Year Data Submission Deadline: Data submitted before may be updated and corrected by using this deadline.
  • Final Reconciliation Run Deadline: The Final Reconciliation Run Deadline represents your last opportunity to submit any updated or missing data.

3. Implement a Proactive Data Collection and Submission Process

Do not wait until the last minute to collect and turn in your data. The following are some recommended procedures:

  • Frequent Data Gathering: Create a system that gathers data on risk adjustments all year long, not just before deadlines.
  • Checks for Data Quality: Throughout the data collecting process, conduct data quality checks to find and fix any errors or discrepancies.
  • Early Submission: To enable CMS validation and prevent any problems, submit your data well in advance of the deadlines.

4. Leverage Technology and Tools

A range of software programs and tools are available to make the process of gathering, validating, and submitting risk adjustment data more efficient. These instruments can assist with:

  • Automate Data Collection: Linking with electronic health records (EHRs) and other data sources may reduce human data entry.
  • Boost Data Quality: While entering data, tools can provide real-time feedback and detect incomplete or missing data.
  • Simplify Submission: Enable quick and easy data preparation and CMS submission.

5. Communication and Training Are Key

  • Internal Communication: Ensure that the teams responsible for coding, data input, and quality assurance are knowledgeable about submission guidelines and deadlines.
  • Continuous Instruction: Regularly conduct training sessions on quality metrics, coding standards, and risk adjustment data gathering.

Consequences of Missing Deadlines

Despite the possibility that CMS will accept data provided after the initial deadline for inclusion in later windows, there are significant disadvantages:

  • Reduced Reimbursement: The final risk score calculation will not take into account data provided after the final deadline. As a result, your organization’s capitated payments may decrease, which would affect your financial resources.
  • Added Workload: Rushing to submit information at the last minute might result in data inaccuracies and inconsistencies. Early submission makes the process run more smoothly and gives enough time to fix any problems with the quality of the data.

Conclusion

MAOs can guarantee correct and timely data submissions by being aware of CMS risk adjustment reporting dates and taking a proactive stance. This enhances Medicare Advantage program efficacy overall and optimizes reimbursements. Keep in mind to prioritize data quality all year long, utilize technology, create a clear calendar, and bookmark important sites. With careful planning and execution, you can prevent last-minute scurrying and guarantee a seamless risk adjustment submission procedure in 2025.