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Risk Adjustment Data Validation (RADV) Audits: What You Need To Know

posted by AHIP

on June 7, 2016

Key Takeaways

High standards of accountabilityMedicare Advantage plans are committed to meeting high standards of accountability in compliance with Medicare Advantage program requirements, including those designed to ensure payment accuracy.

Potential care disruptionCMS’ proposed changes to the RADV audit process are inadvisable in their current form and could disrupt care for enrollees.

 

Fewer payment errorsMedicare Advantage has a better track record compared to traditional fee-for-service Medicare with fewer payment errors.

 

Background

Payments to Medicare Advantage plans are adjusted based on health risk of enrollees. The goal of risk adjustment is to ensure beneficiaries, including those with chronic conditions, are enrolled in plans that are appropriately reimbursed to meet their individual health needs.