10 Medical Records
10.6 Risk Adjustment Data Validation
Participation in risk adjustment data validation is required of all providers, and it is important that you are aware that medical records will be requested from your office. Data validation through a review of medical record documentation ensures the accuracy of risk-adjusted payments. These medical record reviews verify the accuracy of claim and encounter data and identify additional conditions not captured through this mechanism.
IntegraNet collects and reviews records for Risk Adjustment Data Validation on a quarterly basis. Under CFR 164.502 (HIPAA implementation), providers are permitted to disclose requested data for the purpose of health care operations after they have obtained the general consent of the member. A general consent form should be an integral part of your medical record file.
More information related to risk adjustment can be found at www.cms.gov.