Data Audit

Medicare Advantage RADV Final Rule Changes: With an Expected Audit Recovery of Nearly $5B in Next 10 Years, Will Your Plan Face an Audit?

On February 17, 2023 / Data Audit, Risk Adjustment

The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by the Centers for Medicare and Medicaid Services (CMS) to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member,

RADAR on Medicare Advantage | With Final RADV Rule Out, MAOs Are Advised to Clean Up Risk Adjustment Practices

On February 2, 2023 / Data Audit, Media Coverage

Medicare Advantage organizations may not have gotten the outcome they were hoping for in CMS’s recently finalized Risk Adjustment Data Validation rule, but industry experts say they weren’t surprised by the position CMS ultimately took after years of pressure to close out RADV audits and recover identified

Medicare Advantage RADV Final Rule Changes: With an Expected Audit Recovery of Nearly $5B in Next 10 Years, Will Your Plan Face an Audit?

RADAR on Medicare Advantage | With Final RADV Rule Out, MAOs Are Advised to Clean Up Risk Adjustment Practices

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