What should healthcare organizations maintain to ensure documentation readiness for RADV audits?

Maintaining a comprehensive and accurate medical history for each patient is crucial for ensuring documentation readiness for Risk Adjustment Data Validation (RADV) audits. This comprehensive documentation serves several key functions. It supports accurate coding and billing processes, ensuring that the healthcare organization receives appropriate reimbursement based on the severity and complexity of patients' conditions. Additionally, comprehensive records are vital for demonstrating compliance with regulatory requirements and quality standards during an audit.

Moreover, thorough documentation helps to provide a clear and detailed understanding of patient care, which is essential in validating the diagnoses reported to payers. Accurate and comprehensive medical histories enable organizations to substantiate the risk-adjusted payments they receive. They also mitigate the risk of financial penalties that could arise from discrepancies or inaccuracies identified in the audit process.

While minimal interaction records or records limited to high-risk patients may seem like a functional approach, they do not provide the necessary depth required for thorough compliance and validation. Similarly, patient consent forms, while important, do not contain the clinical information needed to support diagnosis-related claims in the context of RADV audits. Thus, having a complete medical history is fundamental for both compliance and optimal operational performance.