Medicare Advantage (MA) Risk Adjustment Data Validation (RADV)

The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) Recovery Audit Contractor (RAC). The purpose of this RFI is to solicit feedback from industry related to expanding the RAC program to Medicare Part C. The purpose of this draft Statement of Work (SOW) is to solicit feedback, gauge interest, and conduct market research regarding CMS entering into a contract with a RAC to identify underpayments and overpayments associated with diagnosis data submitted to CMS by Medicare Advantage Organizations. CMS currently conducts Risk Adjustment Data Validation (RADV) audits to validate the accuracy of diagnosis data submitted to CMS for payment by Medicare Advantage Organizations and to recover net overpayments associated with inaccurate diagnosis data. As currently structured, this SOW, for a Part C RAC, would incorporate the RAC into the RADV audit process, and have the RAC conduct additional audits of diagnosis data submitted to CMS by Medicare Advantage (MA) Organizations. This is not an invitation for bid, request for proposal or other solicitation and in no way obligates CMS to award a contract. The sole intent of this Request for Information is to obtain information pertaining to Part C RAC planning purposes. No reimbursement will be made for any costs associated with providing information in response to this RFI and any follow-up information requests. Respondents should mark their responses if the information is business confidential. Respondents will not be notified of the results of the market research.