What is the primary purpose of conducting RADV audits?

The primary purpose of conducting RADV audits is to validate risk adjustment data for accuracy and completeness. This process is essential because it ensures that the health plan organizations are correctly receiving the appropriate risk-adjusted payments based on the true health status of their enrolled members. By confirming the accuracy of diagnoses and the corresponding data submitted, RADV audits help maintain the integrity of the Medicare Advantage program, ensuring that resources are allocated effectively and that high-quality care is provided to patients.

Focusing specifically on the data involved allows for a more rigorous oversight of the coding practices employed by healthcare providers, enhancing the overall trust in the financial transactions that underpin the healthcare system. This validation process not only supports compliance with regulatory requirements but also fosters an environment where quality of care is prioritized, ultimately benefiting both patients and providers.