What Are Risk Adjustment Data Validation (RADV) Audits?
Auditing

What Are Risk Adjustment Data Validation (RADV) Audits?

As discussed last week, payments to Medicare Advantage (MA) plans are adjusted to account for expected healthcare resource consumption by enrollees. Higher risk scores increase payments. The primary risk adjustment mechanism is the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Categories (CMS-HCCs). Diagnoses reported on inpatient and qualified

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Big Consulting Firms and Data Profiteering
CMS

Big Consulting Firms and Data Profiteering

Here’s the uncomfortable truth: many hospitals and state Medicaid plans, under pressure from HR1 data analysis needs, are paying eye-watering markups to for-profit CPA and

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Getting Ahead of the RADV Audit Curve
CMS

Getting Ahead of the RADV Audit Curve

EDITOR’S NOTE: This piece on RADV audits, written by Frank Cohen, was published on RACmonitor on Aug. 25, 2025. It’s being republished on ICD10monitor because

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