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

Lesson 4 Summary

  • CMS has set 95% as the passing DV threshold for each reporting section, as well as for the Part C, Part D, and combined scores.
  • A standard, sub-standard, or data element that gets a “No” or 1, 2, or 3 finding will result in a score of zero percentage points.
  • A 4 finding will result in 75% of the maximum possible percentage points for the standard, sub-standard, or data element.
  • A “Yes” or a 5 finding will result in 100% of the maximum possible percentage points for that standard, sub-standard, or data element.
  • The sum of the scores determines the overall Part C, Part D, and combined reporting sections scores. SOs compare the scores against the annual threshold to determine Pass/Not Pass status.
  • SOs may ask for an appeal in writing for any Not Pass determination within 5 business days following the June 15 DV deadline.
  • CMS requires DVCs to produce an archive of work papers which SOs keep and make available upon CMS’s request.

  • SOs should set up a secure repository to archive working papers given by the DVC for 10 years.