May 1, 2025
Some of your patients could be included in the U.S. Department of Health and Human Services Risk Adjustment Data Validation Audit, conducted by the Centers for Medicare & Medicaid Services. The HHS-RADV audit is expected to begin in June 2025.
How you can help: If you have patients included in the audit, you’ll receive a letter from CMS with an attached medical records request. It’s important to respond to this request by the date in the letter. As contracted providers, you’re required to validate diagnosis codes used in the Affordable Care Act risk adjustment risk score calculation.
What the data is used for: The HHS-RADV audit validates the data used when assessing the payment transfers for the ACA. The audit is performed on a sample of members enrolled in ACA-compliant individual and small group plans. The HHS-RADV audit validates medical claims of the sampled members and requests all medical records tied to 2024.
If you have questions, contact our RAVI-IFM department.