Can a request for recalculation from the plan be requested when inaccurate diagnosis codes are identified after the final risk score is determined?

The correct answer is based on the understanding of how the Risk Adjustment Data Validation (RADV) process operates regarding the identification of inaccurate diagnosis codes. Plans have the ability to request a recalculation if they find that an inaccurate diagnosis code has been identified, and such inaccuracies would impact the final risk score used for determining payments.

In the context of risk adjustment, the accuracy of diagnosis coding is crucial, as it directly affects the financial reimbursement that a plan receives. If a diagnosis code is proven to be incorrect and this has repercussions on risk assessment, the plan must be allowed to rectify the situation to ensure appropriate payment adjustments and resource allocation. This mechanism is essential for maintaining the integrity of the payment system and ensuring that funds are allocated based on accurate health conditions of beneficiaries.

The mechanisms to request recalculations are generally prioritized to ensure that any inaccuracies can be corrected efficiently. Thus, the rationale supports that plans can act when inaccuracies are discovered that have implications for their financial performance based on risk scores.