What are common audit findings in RADV audits?

The identification of missing documentation and unsupported codes as a common audit finding in RADV audits is significant because accurate and complete documentation is essential for validating the coding of diagnoses. In the RADV process, the auditors review medical records to ensure that the diagnoses submitted for risk adjustment are not only present but are also supported by appropriate clinical documentation. When documentation is missing, it raises concerns about the legitimacy of the codes reported, which can lead to incorrect risk adjustments and financial discrepancies.

Additionally, unsupported codes can lead to improper claims for reimbursements, ultimately affecting the financial integrity of healthcare plans. In RADV audits, the emphasis is placed on ensuring that every diagnosis reported meets the criteria for validation, making the presence of comprehensive and supportive medical records crucial. This focus helps maintain accountability in risk adjustment practices and ensures that funds are allocated appropriately based on accurate patient data.

While other options may reflect issues that can occur in healthcare settings, they are not the primary focus of RADV audits, which specifically target the accuracy and appropriateness of coding and documentation related to patient diagnoses and risk adjustment.