Medicare Advantage Data Validation: Ensuring Accuracy & CMS Compliance

1. Medicare Advantage Data Validation Ensuring Accuracy & CMS Compliance

2. What is Medicare Advantage Data Validation? Definition: Medicare Advantage Data Validation is the process of verifying the accuracy and integrity of data submitted by Medicare Advantage (MA) organizations to CMS. Purpose: Ensures that reported data (such as HEDIS, enrollment, claims, or risk adjustment) is complete, accurate, and compliant with federal standards. Why it matters: Impacts star ratings, reimbursements, and regulatory compliance Supports transparency and informed decision-making

3. Importance of CMS Data Validation in MA Plans • CMS Oversight : • CMS mandates regular audits and validation checks to verify the accuracy of submitted data. • Implications for MA Plans : • Financial penalties for incorrect data • Loss of incentives or plan ratings • Risk of public scrutiny • Types of CMS Data Validation : • HEDIS audits • Risk Adjustment Data Validation (RADV) • Encounter data validation

4. Best Practices in Medicare Advantage Data Validation 1. Conduct Internal Audits Regularly: Proactively validate claims, HEDIS, and member data before CMS audits. 2. Leverage Technology: Use advanced tools and platforms for automated validation and error detection. 3. Partner with Experts: Collaborate with data validation vendors or consultants for deeper accuracy and audit preparedness. 4. Documentation & Training: Maintain complete records and ensure team training on CMS and URAC guidelines.

5. Thank You Expert HEDIS & HIPAA Consulting Services Contact Us For more insights on Medicare Advantage Data Validationand how to streamline your CMS Data Validation process, feel free to contact us. • +(713) 581-4320 • 14019 SW Freeway, Suite 301-705 Sugar Land, Texas 77478 • www.healthspective.com