Relevant to: All Medicare Advantage Organizations, PACE Organizations, Medicare-Medicaid Plans, Section 1833 Cost Contractors and Section 1876 Cost Contractors, and Demonstrations
The purpose of this memo is to notify all Medicare Advantage (MA) Organizations and other entities that submit risk adjustment data of the payment years for which CMS intends to rerun risk scores for payment recovery during calendar year (CY) 2024. Section 1128J(d) of the Social Security Act requires that overpayments received under title XVIII or XIX to which an entity is not entitled must be reported and returned no later than 60 days after it was identified by the entity. Once an MA organization has identified that incorrect diagnosis data were submitted, the MA organization is responsible for deleting the incorrect diagnosis data through the established submission process for the Risk Adjustment Processing System (RAPS) and/or the Encounter Data Processing System (EDPS) (42 CFR 422.310(d)(2)). The obligation to delete incorrect diagnosis data applies regardless of whether the MA organization identifies the incorrect diagnosis data prior to the risk adjustment deadline (open period deletes) or after (closed period deletes).