What is a primary goal of conducting RADV audits?

The primary goal of conducting RADV audits is to provide accurate assessments of risk scores submitted. These audits are crucial for validating the risk adjustment data reported by healthcare organizations, ensuring that the information reflects genuine patient conditions and diagnoses. By focusing on accurate assessments, RADV audits help maintain the integrity of risk adjustment models, which are essential for appropriate reimbursement rates. This accuracy is vital for both healthcare providers and payers, as it affects funding and resource allocation.

In the context of RADV, ensuring that risk scores accurately represent the patient population leads to fair compensation for the level of care provided, ensuring that providers are not under-funded or over-funded based on incorrect data. This focus on accuracy directly supports the overarching goal of promoting the quality and effectiveness of care in the healthcare system.