Overview
CMS is significantly expanding its Risk Adjustment Data Validation (RADV) audits for Medicare Advantage (MA) plans, covering prior payment years 2019 through 2024 and extending to future payment years. These audits will be conducted on an unprecedented scale and timeline, with CMS aiming to complete all prior year audits by early 2026. With CMS proposing to audit each MA plan contract each year going forward and extrapolate audit results, proper preparation is essential.
Our speakers will cover:
- A summary of CMS’s Updated RADV Audit Protocols: Expanded audit scope and full-contract extrapolation.
- Historical and Regulatory Context: Insights into the last 15 years of CMS audit activity and broader regulatory trends.
- Practical, Strategic Next Steps for MA Plans, Providers, and Vendors: Assessing risk, strengthening compliance, and managing medical record documentation under tighter timelines.
