RADV Webinar Series Part 1: Mechanics for Providers

On-Demand

Event Summary

In an effort to crack down on fraud, waste and abuse (FWA) in Medicare Advantage (MA) plans, the Centers for Medicare & Medicaid Services (CMS) announced a sweeping initiative in late May 2025. CMS is fast-tracking the completion of outstanding Risk Adjustment Data Validation (RADV) audits—and launching a significantly expanded round of new audits starting September 1, 2025. These audits are critical to ensuring the accuracy and integrity of health plan data – with far-reaching implications for providers, plans and patients.

While health information professionals are familiar with Affordable Care Act (ACA) and MA risk adjustment reviews, it’s unlikely many of them have seen a RADV audit. And because this has been a limited program for eight years, health information professionals and health plans may need a refresher.

The current administration wants to finish all remaining RADV audits for payment years (PY) 2018-2024 by early 2026. CMS is increasing the number of medical records it will audit per health plan from 35 records to 200. All MA plans will need to complete RADV audits – a change from a sample of 65 plans to approximately 550 plans nationwide. With the increased parameters, this RADV initiative has the potential to disrupt routines for providers and payers.

Join us in this three-part series as we discuss how to prepare if your team encounters these types of requests:

• Part 1: RADV mechanics for providers. We’ll review program fundamentals, discuss the difference between full-fledged and targeted audits, and dive into best practices.
• Part 2: RADV updates for payers. We’ll tackle changes to the RADV program, CMS’ motivation behind changes to the audits, and tips about working with providers.
• Part 3: Latest and greatest updates so you’re ready to tackle RADV head-on.

Learning Objectives

1. Understand the importance of maintaining accurate records, ensuring all diagnosis data is accurately documented and updated.

2. Realize the significance of providing ongoing training on proper documentation practices, releasing appropriate records, and RADV compliance requirements.

3. Recognize how to create an action plan to identify RADV audits and notify management when they’re received to maintain compliance with CMS regulations.

This program has been approved for (1) continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

To receive this on-demand CEU, you must:

1. Complete the form above to access the recording
2. Take the post-event survey, which will be emailed to you from [email protected] within 24 hours

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