What constitutes a finding in a RADV audit?

In a RADV audit, a finding is primarily identified as any discrepancy between the diagnosis codes that have been submitted and the corresponding medical record documentation. This concept is crucial because the purpose of the RADV audit is to ensure that the risk adjustment process accurately reflects the health status of beneficiaries based on documented diagnoses.

When discrepancies arise, it indicates potential inaccuracies in the coding submitted to payers, which could affect reimbursement and risk adjustment calculations. Accurate documentation is essential for substantiating the diagnoses coded, ensuring that they are well-supported in the medical records. Therefore, finding such discrepancies highlights areas where there might be issues that need resolution to maintain the integrity of claims and proper risk adjustment.

While the other options may pertain to various aspects of healthcare compliance and financial integrity, they do not directly align with the specific focus of a RADV audit, which is centered on the accuracy of diagnosis coding supported by medical documentation.