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2025 Medicare Part C & Part D Reporting Requirements & Data Validation

Reporting Findings for Standards Using Binary Scale

You should apply this threshold to standards that need the review of policies and procedures when possible to quantify the adherence to or implementation of said policies and procedures. Table 20 provides an example of how to determine if the minimum threshold was met to determine a Yes finding for Sub-Standard 1.e:

Table 20: How to Determine if the Minimum Threshold was Met to Determine a "Yes" Finding for Sub-Standard 1.e
Sub-StandardStandard DescriptionMinimum Threshold for a "Yes" Finding
1.eSOs properly applied version control of source documents.SO properly applies version control of source documents. 11 out of the 12 months in the contract year, the SO started the enrollment system update policy as it’s written (11/12 = 91.6%).

Note: For those reporting sections reported to CMS on a quarterly basis like Part D Coverage Determinations and Redeterminations, CMS expects DV reviewers to apply the 90% threshold in aggregate based on all data submitted throughout the reporting year. DV reviewers shouldn’t determine findings at the quarterly level.