How long must plans retain documentation relevant to the RADV audit?

The requirement for plans to retain documentation relevant to the RADV audit is set at a duration of at least ten years. This retention period allows for adequate oversight and verification of data used in risk adjustment calculations. By maintaining documentation for ten years, organizations ensure compliance with regulatory requirements and can support the accuracy of reported data, which is essential for proper risk adjustment and reimbursement processes.

In the context of risk adjustment, thorough documentation is necessary to substantiate claims and clinical findings that affect the risk scores used to adjust payments. Retaining this information for a decade provides a buffer period that aligns with the typical duration of audits and investigations that may occur, allowing organizations to defend their coding and billing practices if necessary.

This comprehensive retention policy reflects the importance the Centers for Medicare & Medicaid Services (CMS) places on data integrity and accountability in risk adjustment programs.