Quality Assurance for Continuous Improvements

Centers for Medicare & Medicaid Services (CMS)

CMS is responsible for all risk related programs under the Medicare Modernization Act (MMA), including determining contract-level risk adjustment for Medicare payments from providers. SCG provides comprehensive independent quality assurance of the Risk Adjustment Data Validation program through business and technical oversight, statistical sampling and surveillance, automated testing and validation. This quality assurance provided on CMS’s risk adjustment program proactively resolves issues and defects and has contributed to improvements in the programs mandated timelines and accuracy of outcomes.