RADV Audit Services

In order to verify initial risk adjustment claims, Medicare Advantage (MA) plans regularly undergo RADV audits from CMS. As a medical billing and coding company, Outsource Strategies International (OSI) adopts the right strategies that can help payers and physicians make the most of the risk adjustment process. Our RADV audit services for insurance companies helps to establish whether the diagnosis codes submitted can be validated by medical record documentation.

This Risk Adjustment Data Validation (RADV) audit is intended to verify the diagnosis codes submitted for payment through medical record documentation, ensuring integrity and accuracy. Such audits can be a time-consuming task for health plans. We have the resources and technology to handle high volume jobs to meet the annual deadline. Our team has been providing audit solutions for several years and we are confident in our ability to help health plans successfully meet their requirements.

Health plans that are selected to participate in a RADV Audit have to submit member medical records to validate diagnosis data previously reported to the CMS. The audit verifies whether the diagnosis codes submitted by the MA plan is supported by the medical record documentation for a member. The validation takes place after the data is collected and submitted to CMS, and payment has been made to the MA health plan by CMS.

Our skilled team can assist MA plan providers to prepare for RADV audits, review medical records submitted with claims and check whether the right ICD-10 codes are assigned.

Our services aim at making your MA plans meet CMS contract requirements. Call 1-800-670-2809 for a Free Trial.

Mock RADV Audits

OSI’s mock RADV audit services help you confirm reported diagnoses and identify ICD-10 coding errors. Errors in provider documentation can also be identified to prevent a negative impact on your overall RAF (Risk Adjustment Factor) score.

Our mock audit process follows the CMS’ audit model, resulting in true audit experience and reliable results for your programs. The process includes:

  • Identifying specific medical records based on the high risk factor
  • Reviewing physician and coding documentation for confirming reported diagnoses
  • Retrieving and examining charts to identify all possible HCC codes
  • Identifying incorrect ICD-10-CM codes and missed/unreported data and other coding errors
  • Reviewing medical records to validate adherence to RADV documentation requirements
  • Reporting audit analysis based on your specific plan

This mock audit helps streamline your internal processes for an authentic audit. Our coders are also experienced in MRA/HCC coding with validation for RADV.

With our mock RADV audit services, insurers can ensure accuracy of their providers’ coding and documentation to meet CMS contract. We make your plans ready for the federal audit and thus accurate reimbursement.

Comprehensive Physician Support Services

It is important for physicians and their office staff to be aware of the risk adjustment audits because medical record documentation may be requested by the Medicare Advantage health plan. Physicians will be required to assist the health plan by providing medical record documentation for members included in the audit. We help physicians with medical record review, preparing documentation and data retrieval and reporting.

Our Audit Service Highlights

  • Efficient workflow process
  • Reliable data and reports
  • HIPAA-compliant services
  • Competitive pricing to save 30-40% on costs
  • Comprehensive customer support

We also offer comprehensive RADV consulting services. If you haven’t been able to prepare your plan for the audit, OSI can help with customizable and flexible solutions focused on specific plans.

Ensure your RADV audit readiness with our reliable services – contact us today at 1-800-670-2809!