Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)

Medicare Part C and Part D Reporting Requirements
Data Validation Procedure Manual
Appendix 4: Instructions for Findings Data Collection Form for Data Validation
Reviewers
Version 5.0

Prepared by:
Centers for Medicare & Medicaid Services
Center for Medicare
Medicare Drug Benefit and C & D Data Group

Appendix 4: Instructions for Findings Data Collection Form, Version 4.0

Table of Contents
1

OVERVIEW OF FINDINGS DATA COLLECTION FORM AND EVALUATION
PROCESS .......................................................................................................................................... 3
1.1
1.2

Record Findings at the Reporting Section Level or the Reporting Section’s Data
Element Level............................................................................................................................ 3
Structure of Findings Data Collection Form ............................................................................. 3

List of Exhibits
Exhibit 1: Overview of Findings Data Collection Process and Pass/Not Pass Determination ..................... 3

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Appendix 4: Instructions for Findings Data Collection Form, Version 4.0

1 OVERVIEW OF FINDINGS DATA COLLECTION FORM AND
EVALUATION PROCESS
The Findings Data Collection Form (FDCF) is a tool for reviewers to record their data validation findings for each
contract included in the scope of the data validation review. The form mirrors the content of the Data Validation
Standards document, but allows the reviewer to record notes, data sources referenced, and findings for the different
standards and criteria specified for a given reporting section. An overview of this process is depicted in Exhibit 1, below.
Exhibit 1: Overview of Findings Data Collection Process and Pass/Not Pass Determination

Collect OAI,
Samples,
Source Code,
Site Visit Notes,
etc.

Findings Data Collection
Form
(Allows for specific
findings to be captured)

Determine
Compliance
with Data
Validation
Standards
Data entered
into HPMS
Complete
Findings Data
Collection Form

Data Validation Contractor
(Pre-HPMS Processes)

Translate
findings from
Findings Data
Collection Form
into Pass/Not
Pass
Determination

Pass/Not Pass
Determination

CMS

Using the FDCF, the reviewers will conduct the review and record reporting section-level, and in some cases data
element-level, findings for each reporting section’s standards. Once the findings have been finalized the reviewer will
share them with the organization and then submit the completed FDCF to CMS via the Health Plan Management System
(HPMS). CMS will then evaluate the reporting section- or data element-level findings for each reporting section’s
standards to derive an overall “Pass” or “Not Pass” determination.

1.1

RECORD FINDINGS AT THE REPORTING SECTION LEVEL OR THE REPORTING
SECTION’S DATA ELEMENT LEVEL

While most data validation standards and criteria are assessed at the reporting section-level (e.g., Standard 1, a review of
source documents indicating that all source documents accurately capture required data fields and are properly
documented), some are assessed at the data element-level (e.g., Standard 2.e examines each data element for compliance
with reporting section criteria). Depending on the level of assessment for each standard and criteria, reviewers will record
results in the FDCF at the reporting section-level or at the reporting section’s data element-level.
The standards and criteria that involve data element-level reviews are Standards 2.e and 3.a, specifically, as they assess
the accuracy of reported results that may vary across data elements reported by the organization. Reviewers must refer to
the reporting section criteria for Standard 2.e in their evaluation.

1.2

STRUCTURE OF FINDINGS DATA COLLECTION FORM

The content in each reporting section form mirrors the data validation standards and includes space for the reviewer to
record data sources, review results, and findings for a given reporting section. Reviewers should only complete areas
displayed in white for data sources, review results, and findings. Areas displayed in grey are not applicable and should not
be completed. In the "Data Sources and Review Results:" column, the reviewer will enter the review results and/or data
sources used for each standard or sub-standard. In the adjacent "Findings" column, select "Y" if the requirements for the
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Appendix 4: Instructions for Findings Data Collection Form, Version 4.0

standard or sub-standard have been completely met. Select “N” if any requirement for the standard or sub-standard has not
been met.

Please refer to the appropriate technical specifications documents for the Part C and Part D data elements.
The Part C Technical Specifications can be found at: http://www.cms.gov/Medicare/HealthPlans/HealthPlansGenInfo/ReportingRequirements.html
The Part D Technical Specifications can be found at:
http://www.cms.gov/Medicare/Prescription-DrugCoverage/PrescriptionDrugCovContra/RxContracting_ReportingOversight.html

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