Can providers be audited independently of the plans during a RADV audit?

In a Risk Adjustment Data Validation (RADV) audit, providers can indeed be audited independently of the health plans. This is significant because it allows for a comprehensive verification of the coding and documentation practices of individual providers, ensuring that they comply with the standards required for risk adjustment. By auditing providers separately, the process can identify any potential discrepancies or issues related to the accuracy of diagnosis codes that impact the risk scores and ultimately the reimbursement to plans.

The independent auditing of providers enhances accountability and encourages adherence to coding compliance, aside from just focusing on the health plans themselves. This also recognizes that providers have direct responsibilities for the accuracy and completeness of the data they submit, which is crucial for the overall integrity of the risk adjustment process.

This choice highlights the reality that while health plans are responsible for collecting and reporting data, providers are equally accountable for their contributions to that data, making independent audits a necessary component of the RADV auditing framework.