Medicare AdvantageAdministrativeMedium impact
CMS RADV Audit For Medicare Advantage Members
Florida Blue·FL·Medical Policy
We identified it
Jun 16, 2026
Summary
CMS is conducting Risk Adjustment Data Validation (RADV) audits for Medicare Advantage plans for payment year 2021, with results expected by June 2026. This audit will review medical records to validate diagnosis codes used for risk adjustment payments to Medicare Advantage plans.
Action Required
By June 2026: Billing teams and providers should ensure all Medicare Advantage member medical records from 2021 are complete, accurate, and properly document all submitted diagnosis codes. Organize and maintain accessible records for potential audit requests. Incomplete or inaccurate documentation could result in payment recoupments to Medicare Advantage plans.