by Wyn Staheli, Director of Content - innoviHealth
Jun 4th, 2020
On June 2, 2020, HHS published two proposed changes to the Risk Adjustment Data Validation (RADV) protocols for HHS-Operated Risk Adjustment Programs:
- The error rate calculation
- The application of HHS-RADV results
Beginning with the 2019 benefit year, they are proposing to modify the error rate calculation by doing all of the following:
- Modifying the HCC grouping methodology used in the error rate calculation
- Refining the error rate calculation in cases where a healthcare issuer is only slightly outside of the confidence interval for one or more HCC groups
- Modifying the error rate calculation in cases where an outlier issuer has a negative error rate and also has a negative failure rate
They are also proposing a “transition from the current prospective application of HHS-RADV results to an approach that would apply HHS-RADV results to the benefit year being audited.” This would begin with the 2021 benefit year.
The deadline for comments on these proposals is July 2, 2020.
To review the details of these proposed changes, click here to review the Federal Register notice.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.
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