Which type of audit evaluates appropriate risk scores of patients?

The type of audit that evaluates appropriate risk scores of patients is RADV, which stands for Risk Adjustment Data Validation. RADV audits are specifically designed to ensure that the risk adjustment data reported for patients reflects their true health status and the complexity of their conditions. This is crucial because accurate risk scores determine the funding and resources allocated to healthcare providers based on the population they serve.

RADV focuses on validating the diagnosis codes and other data submitted by Medicare Advantage plans to confirm that they have documented and appropriately coded the health conditions of their enrollees. The process relates directly to assessing the accuracy of risk scores, which are used to adjust payments to plans based on the expected health care costs of their members.

In contrast, other types of audits, such as UPIC (Unified Program Integrity Contractor), RAC (Recovery Audit Contractor), and CERT (Comprehensive Error Rate Testing), focus on different aspects of compliance, payment integrity, or error rates related to Medicare and Medicaid services, but do not specifically target risk score validation as the primary objective.