CMS Central Data Abstraction Tool (CDAT) Modernized
Investment ID: 009-000407564
Overview
Program Title
CMS Central Data Abstraction Tool (CDAT) Modernized
Description
CMS conducts Risk Adjustment Data Validation (RADV) audits to validate the accuracy of risk adjustment data submitted to CMS by MA organizations for Part C payments. The purpose of RADV is to measure the extent to which inaccurate diagnosis codes impact HCC assignments and the associated payment for MA beneficiaries. The CMS primary RADV objectives are to: 1) Estimate national payment error; and 2) Estimate contract-level risk adjustment payment error for payment adjustment and payment recovery efforts. To facilitate the RADV process CMS has developed the Centralized Data Abstraction Tool (CDAT). CDAT shall be used to manage the collection and distribution of medical records, medical record abstraction, reconsideration, management of RADV project data, and other project information including some activities related to payment error calculation. The entities involved in using CDAT to facilitate the flow of information will include CMS, RADV contractors and MA organizations.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable
Associated Websites
https://radvcdat.cms.gov/
Investment Detail
CMS conducts Risk Adjustment Data Validation (RADV) audits to validate the accuracy of risk adjustment data submitted to CMS by MA organizations for Part C payments. The purpose of RADV is to measure the extent to which inaccurate diagnosis codes impact HCC assignments and the associated payment for MA beneficiaries. The CMS primary RADV objectives are to: 1) Estimate national payment error; and 2) Estimate contract-level risk adjustment payment error for payment adjustment and payment recovery efforts. CMS conducts annual Medicare Advantage (MA) risk adjustment data validation activities for the purpose of ensuring the accuracy and integrity of risk adjustment data and MA risk adjusted payments. The focus of data validation is on reviewing medical record documentation to verify diagnoses submitted by MA organizations for payment under Medicare Part C. CMS/CPI conducts major risk adjustment data validation project at the contract-level. The contract-level sample is used to calculate an error estimate for a specific MA contract. CMS intends to extrapolate payment error estimates to the MA contract-level based on medical record review findings for the purposes of payment recovery.