CMS Data Validation

CMS has recently announced a requirement for organizations providing Part C and Part D to report certain measures and to conform to data validation standards to ensure that organizations' reported data are reliable, valid, complete, and comparable. These new measures are not HEDIS related but focus on areas such as handling grievances, provider network, agent training and compensation, medication therapy, prompt payment, etc. Organizations are expected to undergo a data validation review effective 2010 for certain Part C and Part D "core" measures.

As part of reporting these measures, CMS has outlined a process of having these measures validated by an outside contractor that is termed the "Data Validation Review Contractor." This contractor will use CMS derived data validation standards to assess the organization's ability to accurately report the required data measures.

In selecting a data validation contractor, CMS requires the contractor to demonstrate expertise in not only the traditional arenas of claims and coding languages, but also requires expertise in Statistics and in Accounting/Finance.

HDC would like to remind you that its Corporate Office team includes a full time CPA with prior audit experience at Pricewaterhouse Coopers, LLP as well as being an MBA. In addition we have on staff 2 PhDs, one of which is also a CHCA and the other's doctorate is in health economics with a strong emphasis in statistics. No other current LO is able to provide these additional expertise directly from their corporate office. (That means HDC is available to provide this support year round!!!!)

New reporting requirements such as these come at a time when organizations' budgets are already facing significant restrictions. While the validation process is outside of the HEDIS area, there is a fair amount of overlap in the assessment of information systems capabilities and the storage/reporting of the required measures. In areas where efficiencies can be gained, such as contracting both HEDIS and Data Validation with one firm, organizations must take advantage of those opportunities.

HDC is ready to work with your organization in the role of the data validation contractor. We are ready to start now and can help you get ready in a time frame that will make sure your organization is compliant with CMS latest audit requirement.

To learn more and get started, please call Paul Ackroyd at (717) 458-0554. You may also contact us here.