CMS Medicare Data Validation Audit


Medicare Part C & D Validation Audits (DVA) are designed to confirm the accuracy and completeness of reported results used in decision making or performance reporting. Examples of DVA include Risk Adjustment for commercial and Medicare plans and performance reporting by Medicare Advantage Organizations (MAOs), Cost Plans, Medicare-Medicaid Plans (MMP), and Part D sponsors to the Centers for Medicare and Medicaid Services (CMS).

In order to ensure the independence of the Data Validation, organizations must not use their own staff to conduct the Data Validation. Instead, MAOs, Cost Plans, MMPs and Part D sponsors are responsible for acquiring external data validation resources.

Learn more about CMS’s Part C & D Data Validation

Meeting Your Data Validation Needs:

Attest has been conducting DVA projects since 1997. In 2019, Attest performed approximately one-fourth of all Medicare Advantage Data Validation Audits in the nation. Our large and diverse market share has enabled us to continually refine our internal processes and tools to reflect best practices. As such, our reputation of excellence and client satisfaction is reflected in our client growth and retention.

Attest has the ideal background and skills to successfully assess Data Validation standards. Attest has been dedicated to auditing and consulting with managed care organizations and pharmacy benefit managers for well over a decade. Our clients run the gamut from small SNPs up to the largest Medicare managed care organization in the country. Our clients include Medicare Advantage sponsors as well as Part D sponsors. We also conduct centralized reviews for PBMs to reduce the burden on plan resources.

A core audit team is assigned to each audit to serve as the primary reviewer. Additional resources for source code review and census/sample validation assist as needed. Access to greater staff expertise allows for efficient completion of documentation review and responses to your communications throughout the year. For example, Attest’s source code review team performs hundreds of hours of manual source code review. The review team averages over 10 years of programming experience and possesses the ability to review all major software packages and programming languages.

We have never missed a reporting deadline. In 2019, Attest marked all 166 contracts final in advance of the CMS deadline. We assure client agreement with the Data Validation results via ongoing tracking and plan review of draft findings prior to submission to CMS.

One of the biggest challenges with Data Validation is ensuring the reporting reflects the updates required by the specifications. Attest employs a Data Validation Steering Committee and individually assigned measure reporting experts who remain aware of the latest specification updates and respond to plan reporting concerns. The sharing of Attest documentation and project requirements in support of the Data Validation review in advance of the start of the project brings a high level of transparency to all steps of the review.

Attest is committed to involving clients throughout the process and keeping them informed of any possible findings. Attest shares a regular issue log, timeline, and status of key deliverables beginning in April to show what remains expected to be submitted as well as any concerns about documentation submitted and reviewed. We believe in no surprises right before the June deadline. Attest remains committed to conducting your Data Validation review in an open, efficient, and reassuring manner.

Attest is HITRUST certified which demonstrates a high level of compliance with HIPAA and the HITECH Act. Attest continually updates the training of its staff to be knowledgeable about HIPAA Compliance. Protecting your data is an Attest priority.

Medicare Data Validation Audits performed by Attest do not present a conflict of interest to performing Medicare Independent Auditor Validation work.

I welcome the honesty, knowledge, and professionalism experienced with each audit performed.
— Established Attest Data Validation Audit Client