CMS has issued a solicitation seeking contractors to support the Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) projects by serving as Medical Record Review Contractors (MRRC) to conduct medical record reviews for various RADV projects.
CMS requires two independent MRRC (MRRC A and MRRC B) to conduct medical record review for various projects including the RADV projects. The work to be performed is described in detail in the RADV Medical Record Review Contractor (MRRC).
This Contractor shall use Quality Improvement Organization (QIO) equivalent principles to identify ICD-9/ICD-10-CM (and blended HCC model) (International Classification of Diseases, Ninth & Tenth Revision, And Clinical Modification) discrepancies that affect future risk adjusted payments to MAOs. Specifically, for all coding related tasks (medical record discrepant confirmation, medical record abstraction, appeals support and ad hoc projects), the Contractor must have ICD-9/ICD-10-CM (and blended HCC model) certified coders.
