In October CMS issued a memo regarding the 2020 Timeliness Monitoring Project (TMP). As in previous years, CMS will once again be conducting an industry-wide monitoring project in 2021.
Beginning with the 2021 TMP, CMS will no longer collect the Part D Coverage Determination Appeals and Grievances universes used to evaluate these measures. The review time period is starting one month sooner, in January.
Part C sponsors with active contracts in both CY2020 and CY2021.
In 2021, data will only be collected to evaluate the timeliness of processing of Medicare Advantage (Part C) organization determinations and reconsiderations; this includes ODAG Tables 5, 6, & 7. The review time period will depend on your enrollment size.
Like the collection for program audits, universe submissions must include data processed in-house and by all First Tier, Down-stream, and Related entities (FDRs) on your behalf. In addition, all universes will be submitted at the Parent Organization level, based on November 2020 total enrollment. Therefore, one universe submission may include data for multiple contracts.
Sooner than you would like. CMS will be conducting this collection in three waves, with the first wave of letters requesting data being issued in January 2021. You will receive a data request email from the following mailbox: TimelinessMonitoring@cms.hhs.gov. This email will include additional instructions on the time period being tested (see above), how to submit the data through the Secure File Transfer Protocol (SFTP), actual deadlines for submission (it’s 15 business days!), and information on when validation webinars will be scheduled.
CMS will run a timeliness analysis on all validated universes and determine a rate of timeliness for each case type. The findings will be reviewed and may result in compliance actions, if necessary, and may have implications for the Star Ratings data integrity reviews for the two appeals measures.
Don’t panic, you’ve got this! And Madena can help. We have dozens of years and just as many audits under our belt. We can support clients by:
It is critically important to get universe preparation correct to ensure the compliant operations of your plan. Data integrity continues to be a CMS priority not only for Star Ratings and IRE data accuracy but also for required Part C & D reporting. Madena can help with expert guidance, monitoring support, and best practices for universe development to address quality and identify potential risks. Contact us at email@example.com, 207.571.9356, or learn more at www.madenasolutions.com.