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Ciox Health LLC

09/25/2020 | News release | Distributed by Public on 09/25/2020 13:08

Additional reconciliation run for CMS PY2020 Risk Adjustment data submission allows more time to close gaps and increase submission accuracy

On September 18, 2020, the Department of Health and Human Services Centers for Medicare & Medicaid Services issued the following message in a memo:

'This memo is to notify Medicare Advantage Organizations, PACE Organizations, Medicare-Medicaid Plans, Section 1833 Cost Contractors and Section 1876 Cost Contractors, and Demonstrations of upcoming deadlines to submit risk adjustment data for use in calculating risk scores for Payment Years (PY) 2020, 2021, and 2022. CMS will be adding an additional reconciliation run for PY2020. All risk adjustment data (Risk Adjustment Processing System (RAPS) Data and Encounter Data System (EDS) Data) that will be included in the listed risk score runs need to be submitted by 8pm ET of the 'Deadline for Submission.'

Risk Score Run Dates of Service Deadline for Submission of Risk Adjustment
2020 Interim Final Run 01/01/2019 - 12/31/2019 Monday, 02/01/2021
2021 Mid-Year 01/01/2020 - 12/31/2020 Friday, 03/05/2021
2020 Final Run 01/01/2019 - 12/31/2019 Monday, 08/02/2021
2022 Initial 07/01/2020 - 06/30/2021 Friday, 09/03/2021

While the 2020 Interim Final Run deadline remains Feb. 01, 2021; this memo officially sets the 2020 Final Run deadline to Aug 02, 2021, allowing Medicare Advantage Organizations six additional months to ensure a complete and accurate data submission. Final Run deadlines have been extended before (in 2017, due to Hurricane Harvey), but not to this level of advance notice and duration. This creates a unique opportunity for health plans to complete secondary reviews of your previously coded charts from 2019 dates of service, perform an additional analytics run to identify unclosed HCC gaps, and launch a supplemental chart chase where low friction retrieval methods are available.

Step-by-step Timeline for Optimizing Your Additional PY2020 Reconciliation Run (2019 Dates of Service):

  1. September 2020 through January 2021 - Active chart retrieval & review operations with a transition to passive chart intake February through July. Continue chart review operations as charts are received.
  2. October 2020 through July 2021 - Leverage the additional six-months before the Final Run submission to improve your coding accuracy and completeness through 2nd level chart reviews.
  3. January 2021 - Analyze and identify any unclosed HCC gaps
  4. February 1, 2021 - Interim Submission deadline for PY2020
  5. February 2021 through March/April 2021 - Initiate a supplemental chart chase where low/no-abrasion retrieval methods are available (e.g., automated EMR extraction, contracted copy services, credentialed EMR remote access)
  6. April 2021 through August 2021 - Execute your chart retrieval and review operations for 2020 Dates of Service.
  7. August 2, 2021 - FinalSubmission deadline for PY2020

Ciox is ready to help MAOs optimize the opportunity afforded by the additional reconciliation run through:

  • Ciox Cross Check ™. Pairing the tireless ability of natural language processing (NLP), artificial intelligence (AI), and comparative analytics to surface potential incremental and unsubstantiated findings from first pass coding results with expert validation by certified coders, Ciox Cross Check™ 2nd level chart review services ensure more complete and accurate submissions without resource-intensive software implementation.
  • Ciox Digital First Retrieval Services. Leveraging unparalleled scale in automated EHR chart extraction, unique integrated operations with Ciox-contracted provider sites (as the market share leader in release of information/copy services), hundreds of credentialed EMR remote access points, and the most comprehensive health information handler/copy service partner program in the industry, Ciox can execute supplemental chart chases with minimal provider abrasion or resource requirements.
  • Ciox Coding Services. Combining deep expertise in risk adjustment coding, with customized approaches that align to customer-defined scope and coding guidelines, the scale of Ciox Coding Services assures the capacity to effectively manage to changing submission timelines and resource requirements while secure onshore and offshore resources allow clients to manage the most cost-effective chart reviews available within each MAO's compliance parameters.

As you catch your second wind, consider secondary reviews and low friction supplemental chases to meet budget for PY2020. Learn more or get started at www.cioxhealth.com/crosscheck