<aside> 📔 Table of Contents
120.3 - Risk Score Verification Tools
(Rev. 114, Issued; 06-07-13, Effective: 06- 07-13, Implementation: 06-07-13)
MA organizations can use a variety of tools to ensure that the risk score reported by CMS is in close alignment with the score that the organization expects to receive.
Table 26 identifies the tools, method of access, and availability. Sections 120.3.1 through 120.3.3 provide information on how an organization can use the tool to increase the accuracy of payment projections.
| Report Name | Access | Availability |
|---|---|---|
| RAPS Return File/RAPS Transaction Error Report | RAPS Mailbox | |
| RPT####.RPT.RAPS_RETURN_FLAT | ||
| RPT####.RPT.RAPS_RETURN_FLAT (zip format) | ||
| RPT#####.RPT.RAPS_ERROR_RPT RPT#####.RPT.RAPS_ERROR_RPT (zip format) | Next business day following data submission |
| RAPS Monthly and Cumulative Plan Activity Reports | RAPS Mailbox RPT####.RPT.RAPS_MONTHLY RPT####.RPT.RAPS_MONTHLY (zip format) RPT####.RPT.RAPS_CUMULATIVE RPT####.RPT.RAPS_CUMULATIVE (zip format) | Second business day of the month | | --- | --- | --- | | Monthly Membership Report (MMR) • MMR Non-Drug • Drug Reports | Through MARx | Monthly | | Model Output Report (MOR) • Part C HCC MOR • RAS RxHCC MOR | Through MARx | Monthly | | Risk Adjustment SAS Programs | http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats Medicare Rates & Statistics – Risk Adjustment Downloads for CMS-HCC, ESRD, RxHCC | 2006-present |
(Rev. 114, Issued; 06-07-13, Effective: 06- 07-13, Implementation: 06-07-13)
MA organizations can use the RAPS Transaction and Management Reports Return to verify the diagnostic data stored in the model.
Table 27 describes the RAPS Reports used as verification tools.