Importance of Monitoring RAPS Data

Importance of Monitoring RAPS Data

  • 12 Feb 0
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As you know the Mid-Year sweep of RAPS data is hastily approaching. The upcoming deadline is Friday, 03/06/15. This deadline pertains to RAPS data from calendar year 2014, which is the basis of payment in calendar year 2015. After the deadline CMS will recalculate current 2015 payments based on any new information received. With this deadline looming, now is a great time to ensure all of your ICD-9 code data has been submitted and accepted by CMS.

Taking steps now to ensure the validity of your RAPS data is a top priority. Monitoring all RAPS data for accuracy and completeness will eliminate any headaches down the road regarding missing or incorrect data. Also, an effective monitoring plan will ensure accurate Medicare payment in 2015 and reduce time spent waiting on the final reconciliation in 2016.

If your Plan utilizes a 3rd party submitter or if you submit the RAPS data on your own it’s important to remember that the process of monitoring and auditing the RAPS data is ultimately the Plans responsibility. Below are a few questions to ask about the effectiveness of your monitoring and auditing plan.

Does your Plan have a solid process in place to monitor and audit RAPS data for accuracy and completeness? Is this done monthly? Is 100% of the data reviewed or is the data reviewed statistically significant? Is there a plan to review current documentation against accepted RAPS records to ensure completeness? Are all acceptable external claims represented in the RAPS data? Do all of your participants have HCCs? Do you have documentation to support all RAPS data on file? Has any data been identified as incorrect? If so, is there a plan for redacting this erroneous data? Lastly, have all of the RAPS errors been reviewed and corrected?

If your Plan has any questions about the process of monitoring and auditing as part of your compliance work plan or if you are just beginning, Capstone can help. We offer customized consultation and training to suit your needs.