Understanding Impact of Medicare Advantage Patients Submitted but Miscategorized as Medicare in Hybrid submission

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    • Type: Other
    • Resolution: Unresolved
    • Priority: Moderate
    • None
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      Multiple organizations are unable to differentiate Medicare vs. Medicare Advantage in Hybrid reports. The patients would be included in the HWR and HWM submission, but would appear as if they are Medicare when their claims would actually be Medicare Advantage. Since payor type is not a linking variable, would these organizations be at risk of missing the Hybrid submission requirements/financial impact ?
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      Multiple organizations are unable to differentiate Medicare vs. Medicare Advantage in Hybrid reports. The patients would be included in the HWR and HWM submission, but would appear as if they are Medicare when their claims would actually be Medicare Advantage. Since payor type is not a linking variable, would these organizations be at risk of missing the Hybrid submission requirements/financial impact ?
    • Elizabeth Butler
    • 816-668-1260
    • Oracle Corporation
    • Understand risk if Medicare Advantage patients are miscategorized as Medicare in Hybrid submission
    • CMS0529v6, CMS0844v6
    • CMS0529v5, CMS0844v5

      Multiple organizations are unable to differentiate Medicare vs. Medicare Advantage in Hybrid reports. The patients would be included in the HWR and HWM submission, but would appear as if they are Medicare when their claims would actually be Medicare Advantage.  Since payor type is not a linking variable, would these organizations be at risk of missing the Hybrid submission requirements/financial impact ?  Or would CMS know from claims which patients are Medicare vs. MA and the organizations would just need to ensure the linking variable (MBI, etc.) match to successfully pass the 95% (proposed 75%) data completeness thresholds and meet IQR participation requirements/ full APU payment? 

            Assignee:
            CHM Admin User
            Reporter:
            Elizabeth Butler
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              Created:
              Updated: