Medicare Risk Adjustment Data Validation Program: Program History
Guidance for the Centers for Medicare & Medicaid (CMS) conducts risk adjustment data validation (RADV) to ensure the accuracy and integrity of risk adjustment data submitted for Medicare Advantage (MA) risk adjustment payments. RADV is the process of verifying that diagnosis codes submitted for payment by an MA organization are supported by medical record documentation.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 18, 2017
Risk Adjustment Data Validation
The Centers for Medicare & Medicaid (CMS) conducts risk adjustment data validation (RADV) to ensure the accuracy and integrity of risk adjustment data submitted for Medicare Advantage (MA) risk adjustment payments. RADV is the process of verifying that diagnosis codes submitted for payment by an MA organization are supported by medical record documentation.
There are two major RADV activities that CMS conducts:
- Contract - Level Samples
- National Sample
The Contract - Level Samples are used to conduct payment recovery from MA organizations. The National Sample is used for annual payment error reporting. For additional information on payment error reporting, follow the below link. /Medicare/Medicare-Advantage/Plan-Payment/PaymentValidation
The information contained on this page pertains to the payment recovery audits.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.