Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Software Code
Program Area: Risk Adjustment (RA)
Question: What regulatory guidance provides information about submission of final diagnosis codes?
Answer: The Preamble of the 2014 Payment Notice provides information regarding the submission of final discharge diagnosis codes. On page number 15499, column 1, it states, "The data to calculate enrollee risk scores for purposes of risk adjustment would include diagnoses reported on institutional and medical claims that result in final payment action or encounters that result in final accepted status". The 2014 Payment Notice can be located at http://www.gpo.gov/fdsys/pkg/FR-2013-03-11/pdf/2013-04902.pdf on the GPO website.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 28, 2019
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