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2008 Risk Adjustment Data Technical Assistance For Medicare Advantage Organizations Participant Guide TABLE OF CONTENTS TABLE OF CONTENTS INTRODUCTION .........................................................................................................................I-1.

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In the past, CMS has used diagnosis submitted into its Risk Adjustment Processing System (RAPS) by MA plans.

What is the Difference Between RAPS and EDPS? Edits: RAPS data is edited for: enrollment, duplicates, and validity of diagnosis codes. EDPS data is edited for: enrollment, duplicates, diagnosis codes, CPT codes as well as coverage and clinical consistencies.

For example, if a person has lung cancer, diabetes without complications, and coronary artery disease, the DCG model would consider lung cancer only, because lung cancer is the diagnosis which predicts the highest future Medicare expenditures.

The RAPS Return File is a flat file format that includes all the records and diagnosis clusters submitted by the MAO or other entity. Any errors identified during the RAPS process will appear next to the field in which the error was found.

The RAPS Return File is a flat file format that includes all the records and diagnosis clusters submitted by the MAO or other entity. Any errors identified during the RAPS process will appear next to the field in which the error was found.

The Regulatory Affairs Professionals Society (RAPS) is the largest global organization of professionals involved with regulatory and quality for healthcare products, including medical devices, pharmaceuticals and biologics, diagnostics, and digital health.

Required - Typically, these fields show the beginning and ending dates of the period covered by a bill. Since the RAP is a request for payment for future services, however, the ending date may not be known. The RAP contains the same date in both the “from” and “through” date fields.

RADV audits are the main corrective action for those improper payments. Through RADV audits, a sample of beneficiary medical records are provided by MAOs, and CMS reviews those records to verify that diagnoses reported for risk adjusted payments are accurate and supported in the medical record.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232