Preparing Medicare Advantage Plans for RADV Audits

This white paper outlines the necessary steps Medicare Advantage (MA) plans should take to prepare for Risk Adjustment Data Validation (RADV) audits as mandated by the Centers for Medicare & Medicaid Services (CMS). With the final rule published on February 1, 2023, MA plans face significant operational and financial implications, including the potential for increased recoveries estimated at $4.7 billion from 2023 to 2032. The paper details the importance of accurate diagnosis coding and proper documentation to support risk scores, emphasizing that errors found in member records could lead to substantial financial repercussions. It presents various strategies for MA plans, such as adopting compliance programs, engaging providers for accurate documentation, and utilizing advanced surveillance technology for data accuracy checks. The paper stresses the need for ongoing internal audits and the importance of choosing the right technology partners to enhance compliance and audit readiness. Overall, the document serves as a guide for MA plans to mitigate risks associated with RADV audits.