Get CMS RADV Audit Help Now

You’ve been chosen for RADV review. Now what?


Each year, CMS selects 30 plan contracts for RADV review. If chosen, CMS will randomly select 201 plan beneficiaries or organization members (sample population) to validate diagnosis- driven HCCs during a specific plan year.

The audit is serious business, and can have major financial impacts, particularly when mistakes that resulted in overpayment are found.

Three Ways DxID Can Help

Analyze data to identify records with highest potential to support RADV HCCs

Selecting and collecting relevant records

Identify non-audit HCCs to help offset plan error rates

And that’s just the beginning.
We understand the ins and outs of the RADV audit process.

Did you know that any additional HCCs found in a MA Contract Level audit must be accompanied by a substantiated audit HCC for the plan to receive additional credit and offset existing error rates? This is substantially different from the PPACA RADV environment where a plan may receive offsetting error rates from any additional HCC provided that the medical record can be tied back to a medical claim in the given audit year.

Can you answer these questions? We can.

  • Should a plan go after all relevant medical records or just those associated with HCC related ICD-9/10s?
  • How will your plan approach the gathering of attestations for records without signatures that meet the RADV requirements? Is it worth bothering providers that have retired to collect attestations?
  • Are you having trouble getting a hold of records because providers have moved locations or retired? Is this problem worth applying for a RADV hardship? Which situations are likely to be granted a hardship exception and which situations are not?

Even if you haven’t been selected for audit, we will improve your coding accuracy and efficiency to ensure accurate compensation and, ultimately, better patient outcomes.

Whether you have just received notification of your RADV audit, or you have been working for months to fulfill your RADV obligations but are just not seeing the successes you had hoped for, DxID can help answer your questions and operationalize the best RADV approach for your plan.
For rapid response, call Mike Dorsett at 855-855-DxID or email mdorsett@dxid.com today.

Get in Touch

Get better with a more accurate picture of participant health. Let’s start with a free consultation.

Call 855-855-DxID or email info@DxID.com

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