What is the definition of physician and outpatient risk data?
The information detailing what constitutes OUTPATIENT & PHYSICIAN RISK ADJUSTMENT DATA is in the ‘Instruction for Risk Adjustment Implementation’. For instructions, go to www.mcoservice.com; CMS Instructions; Draft Instructions for Risk Adjustment Implementation; Risk Adjustment Instructions. • We have had questions surrounding how the RAPS system will edit claims with a discharge date (statement covers through date) prior to 7/1/02 that are submitted after 10/1/02. Since we will continue to submit CY 2003 data on the abbreviated UB92 6.0 format, will this data be edited on the data elements it is edited on today (specifically duplicates, MPN’s, procedure codes) or since it will be passing through the new RAPS system, will only the data elements that RAPS processes be edited (HIC#, diagnosis code, statement covers from and through date)? Any claims submitted on or after October 1, 2002 will be converted to the RAPS format; therefore, only the RAPS data elements will be edited. • How do
Related Questions
- Can a M+C organization submit physician and hospital outpatient data after July 1, 2002 to the existing processing system before RAPS is operational on October 1, 2002?
- What is the difference between Part B Physician/Supplier data and Outpatient data?
- What is the definition of physician and outpatient risk data?
