Quick answer: CMS’s MA RADV audit calendar runs six overlapping payment years, PY2020 through PY2025, launching roughly every two to three months from March 2026 through April 2027. Audits are non-sequential: PY2024 initiates before PY2023 and PY2022. PY2020 and PY2021 are already active. ACA HHS-RADV and HEDIS
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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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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