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

Translating Findings into Scores at the Standard/Sub-Standard & Reporting Section-Level

DVCs evaluate the 7 DV standards for each reporting section. The first 3 standards include 1 or more sub-standards.

CMS weighs Standard 3 more heavily due to the standard’s emphasis on exact calculation and data entry/upload, which is the primary focus of the DV review.

Some sub-standards include an evaluation of each applicable data element for the reporting section. For example, Sub-Standard 3.a requires the DVC to examine each data element to ensure compliance with reporting section criteria. The number of data elements varies depending on the reporting section.

Each standard, sub-standard, and data element is associated with CMS-assigned maximum percentage points and can vary depending on the standard, sub-standard or data element being scored. Table 23, which is an example, illustrates the maximum possible CMS-assigned percentage points at the standard and sub-standard level.

Refer to Section 2.1 of Appendix J for more information on scoring standards, sub-standards, and data elements.

Table 23: Scoring Aggregated at the Standard and Sub-Standard Level
StandardSub-StandardPercentage of
Total Score
11.a1.0%
1.b1.0%
1.c1.0%
1.d1.0%
1.e1.0%
1.f1.0%
1.g1.0%
Standard 1 Subtotal7.0%
22.a10.0%
Standard 2 Subtotal10.0%
33.aVaries
3.bVaries
Standard 3 Subtotal80.0%
41.0%
51.0%
60.0%
71.0%
Total100.0%
Table Description

This table provides the maximum possible CMS-assigned percentage points for different standards and sub-standards involved in the data validation process. Here's a breakdown of the information:

  1. Standard 1
    • Sub-Standard 1.a: 1.0%
    • Sub-Standard 1.b: 1.0%
    • Sub-Standard 1.c: 1.0%
    • Sub-Standard 1.d: 1.0%
    • Sub-Standard 1.e: 1.0%
    • Sub-Standard 1.f: 1.0%
    • Sub-Standard 1.g: 1.0%
    • Standard 1 Subtotal: 7.0%
  2. Standard 2
    • Sub-Standard 2.a: 10.0%
    • Standard 2 Subtotal: 10.0%
  3. Standard 3
    • Sub-Standard 3.a: Varies
    • Sub-Standard 3.b: Varies
    • Standard 3 Subtotal: 80.0%
  4. Standard 4: 1.0%
  5. Standard 5: 1.0%
  6. Standard 6: 0.0%
  7. Standard 7: 1.0%

Total: 100.0%