What aspects are commonly reviewed during a RADV audit?

During a RADV audit, the primary focus is on the evaluation of diagnosis codes, the quality of documentation supporting those codes, and adherence to risk adjustment rules set by regulatory bodies. This is crucial because accurate coding and proper documentation directly impact the risk adjustment process, which affects reimbursement rates for healthcare plans.

The audit assesses whether the submitted diagnosis codes accurately reflect the patient's health status and whether the documentation substantiates those codes. A successful RADV audit ensures that health plans are compliant with regulations and that they are appropriately compensated for the risk profiles of their enrolled members. This process helps maintain the integrity of risk adjustment methodologies and ensures that patients are appropriately categorized for care and funding within the healthcare system.

By focusing specifically on coding accuracy and documentation quality, the RADV audit plays a vital role in maintaining overall compliance and accountability in healthcare financial practices. The other options do not address these critical areas, rendering them irrelevant in the context of RADV audits.