What is the difference between 'chart reviews' and 'medical record reviews' in the context of RADV?

Chart reviews and medical record reviews serve distinct purposes within the context of Risk Adjustment Data Validation (RADV). When considering the correct answer, the emphasis lies on how each review type approaches patient information.

Chart reviews indeed concentrate on specific clinical data points extracted from a patient's medical history. This includes targeted information, such as diagnoses, treatments, and services that directly relate to the risk adjustment coding process. The goal of a chart review is often to ensure that the coding accurately reflects the patient's current health status and the care provided.

In contrast, medical record reviews encompass a broader scope, examining a patient's comprehensive medical history, which may include all encounters, treatments, and various healthcare providers' notes. This thorough examination helps validate the overall completeness and accuracy of the medical documentation.

Understanding the distinction helps in recognizing the methodologies utilized in RADV audits, where precise coding is essential for proper risk adjustment and reimbursement processes. The clarity between these two types of reviews contributes to an effective audit process and improves the reliability of risk scores derived from the reviewed records.