Medicare AdvantageDocumentationHigh impact
Medical Record Requests for Risk Adjustment Data Validation (RADV) Surveillance Audit Program
Healthfirst·Coding
Effective date
Dec 1, 2020
We identified it
Jun 20, 2026
Summary
A Risk Adjustment Data Validation (RADV) surveillance audit program is being implemented that will require healthcare practices to submit medical records for validation of risk adjustment coding. This audit will focus on verifying that diagnosis codes used for risk adjustment purposes are properly supported by medical documentation.
Action Required
By December 2020: Providers and billing teams must prepare for RADV audit requests by ensuring all risk adjustment diagnosis codes are properly documented in medical records. Review documentation for HCC-eligible diagnoses to ensure specificity and medical necessity are clearly noted. Establish process to respond to medical record requests within required timeframes when audit notifications are received.