CMS released the CY2027 Medicare Advantage Final Rule and Rate Announcement within four days of each other. Together, they represent a systematic restructuring of how Medicare Advantage organizations will compete, be evaluated, and be paid. This guide covers six areas of change: what shifted, what’s at stake,
Read More →Introduction For years, risk adjustment followed a predictable playbook: meet deadlines, prepare for annual RADV, and repeat. The new MA RADV audit cycles have rewritten that playbook entirely. In 2026, health plans are simultaneously managing five overlapping MA RADV audit cycles — Payment Years 2020 through 2024
Read More →The landscape of Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) has undergone a seismic shift. CMS is no longer just sampling the industry; they are auditing every eligible contract, every year. With federal estimates indicating roughly $17 billion in annual overpayments due to unsupported diagnoses, the
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Major regulatory forces, from RADV extrapolation to new payment models, are converging. Here is why the next 18 months represent the most significant operational transformation in a decade. The Medicare Advantage sector is facing its most significant operational transformation in a decade. We are no longer looking
Read More →Regional Health Plan Boosts Risk Accuracy and ROI Through Targeted Retrospective Chart Review A regional payer operating across multiple states wanted to close a long-standing gap in risk score accuracy across its Medicare Advantage and ACA lines of business. Despite conducting routine retrospective chart reviews and following
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The Risk Adjustment Data Validation (RADV) rule was finalized by CMS in January 2023 to tighten oversight of Medicare Advantage (MA) plans. A central change was the removal of the fee-for-service (FFS) adjuster, which historically helped normalize error rates seen in MA and with those seen inRead More →
CMS is launching the most extensive RADV audit expansion in Medicare Advantage history. Health plans need to move quickly—and smartly—to reduce risk and limit exposure. One of the most common (and costly) mistakes? Contracting with the same vendors used for retrospective coding. Coders trained for retro reviews may bring
Read More →RADAR on Medicare Advantage, June 5, 2025 Following up on promises to root out fraud, waste and abuse in government-sponsored programs, CMS on May 21 stunned the industry with a bold plan to rapidly expand risk adjustment data validation audits (RADV) used to collect overpayments from Medicare
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Health Plan Weekly, May 30, 2025 Amid a flurry of CMS announcements about health care price transparency and Medicaid issues, the agency on May 21 unveiled a bold plan to collect Medicare Advantage overpayments through the expansion of Risk Adjustment Data Validation (RADV) audits. Industry analysts say the news
Read More →ATTAC’s HHS-RADV Audit Expertise Delivered for Our Clients in 2024 ✨ Overall Validation Rate: 94.2% 🚫 Overall Non-Validation Rate: 5.8% 🔍 Our Enhanced Audit Efficiencies Include: 📌 >99% claims matching rate 📌 Experienced in-house, on-shore ACA coding team 📌 Dedicated and experienced audit managers 📌 Web-based reporting
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