CMS Risk Adjustment Submission Deadlines

It’s that time of year again—submission deadlines for risk adjustment data are just around the corner. Let's dive into the essentials, with a twist of fun to keep you awake! 

The Why and Who 

CMS (Centers for Medicare & Medicaid Services) is reminding all Medicare Advantage Organizations, PACE Organizations, Medicare-Medicaid Plans, Cost Contractors, and demonstration plans about the crucial deadlines for submitting risk adjustment data for Payment Years (PY) 2024, 2025, and 2026. If you fit into one of these categories, keep reading! 

The What 

Risk adjustment data, including both RAPS (Risk Adjustment Processing System) Data and EDS (Encounter Data System) Data, needs to be submitted on time. And by on time, we mean by 8 PM ET on the deadline day. Any data submitted after this deadline won't be included in the respective risk score run—no exceptions! 

The How 

Here's the plan to stay ahead of the game: 

  1. Initial Run: Submit your data by the initial deadline to be included in the initial risk score calculation. 

  1. Mid-Year Run: Missed the initial deadline? No worries, you can still submit by the mid-year deadline to be included in this run. 

  1. Final Run: Ensure all data corrections and updates are done before the final deadline, as CMS won't accept new diagnoses after this point—only deletions. 

The When 

Mark your calendars with these key dates: 

  • 2025 Initial: Data from 07/01/2023 – 06/30/2024 is due by 09/06/2024 

  • 2024 Final Run: Data from 01/01/2023 – 12/31/2023 is due by 01/31/2025 

  • 2025 Mid-Year: Data from 01/01/2024 – 12/31/2024 is due by 03/07/2025 

  • 2026 Initial: Data from 07/01/2024 – 06/30/2025 is due by 09/05/2025 

  • 2025 Final Run: Data from 01/01/2024 – 12/31/2024 is due by 02/02/2026 

Next Deadline Alert! 

Heads up! The next critical deadline is for the 2025 Initial Run. Make sure your data from 07/01/2023 – 06/30/2024 is submitted by September 6, 2024. Don't let this sneak up on you—set your reminders now! 

Pro Tips for Submission Success 

  • Early Bird Gets the Worm: Submit your data early to handle any potential issues like validation errors or data rejections. 

  • Double-Check: Make sure your data is accurate and complete before submission deadlines to avoid last-minute scrambles. 

  • Stay Updated: Keep an eye on communication from CMS for any updates or changes to submission guidelines. 

Got Questions? 

For any burning questions, email riskadjustmentpolicy@cms.hhs.gov. Make sure to use the subject line: "HPMS Memo- Deadline for Submitting Risk Adjustment Data for Use in Risk Score Calculation Runs for Payment Years 2024, 2025, and 2026." 

Remember, staying organized and ahead of deadlines can save a lot of stress—and possibly your sanity. Happy submitting!