Medicare Advantage Risk Adjustment Data Validation Program
Medicare Advantage Risk Adjustment Data Validation Program
About the Program
A CMS Strategic Pillar is to protect the Medicare, Medicaid and Marketplace programs for future generations by serving as a responsible steward of public funds. The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program is CMS' primary way to address overpayments to Medicare Advantage Organizations (MAOs). During a MA RADV audit, CMS confirms that any diagnoses submitted by an MAO for risk adjustment are supported in the enrollees' medical records. If diagnoses are unsupported by the medical records, CMS may collect overpayments. MA RADV audits occur after the final risk adjustment data submission deadline for the MA contract year.
Questions about the MA RADV program should be sent to: RADV@cms.hhs.gov
Announcements
- Payment Year 2018 MA RADV Audit Methods & Instructions – 11/15/2024 (PDF)
Audit methods and instructions to Medicare Advantage Organizations with contracts selected for a payment year (PY) 2018 contract-specific RADV audit. Points of contact for audited MA contracts separately received an audit notice and a version of this document via the Health Plan Management System.
- Payment Year 2018 RADV Questions and Answers – 11/15/2024 (PDF)
View the recently published RADV Questions and Answers page for general and payment year specific questions and answers about the MA RADV program.
Page Last Modified:
11/15/2024 07:58 AM