Every year, CMS increases the number of Risk Adjustment Data Validation (RADV) audits it conducts on Medicare Advantage (MA) plans. RADV audits calculate the accuracy of an MA’s risk adjustment conditions based on beneficiary data. The audits validate inpatient, outpatient, and physician medical records and substantiate retrospective payments, prospectively calculate payments to MA plans, and calculate beneficiaries' overall risk score. Then, CMS adjusts the MA payments accordingly.
Up to 201 enrollees from each contract can be audited. The beneficiaries are chosen based on clinical and enrollment data, including length of coverage and their Medicare Part B coverage.
But did you know that if your organization was unlucky enough to be audited, you might find your monthly CMS payments reduced or, worse yet, be required to pay penalties?
That doesn’t have to be the fate of your organization though. By performing an internal audit, you can ensure your organization is receiving all the revenue you deserve. To make sure you’re not caught off guard, we’ll be presenting a new webinar, “How to Prepare Your Organization for a RADV Audit,” where we’ll explore:
- What a Real RADV Audit Looks Like
- How Documentation Tips and Tricks Can Help Validate HCCs
- Some of the Proposed CMS Updates For The 2020 Collection Year