Risk, Readiness, Results:
RADV Audit Webinar Series

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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.

July 31, 2:00 pm ET
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.

August 21, 2:00 pm ET
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.

September 25, 2:00 pm ET
Be ready to tackle RADV head-on.

Join Us!

Learning Objectives

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

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

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



Each webinar in this series is approved for (1) continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

To receive this CEU:

  1. Register and attend the live webinar
  2. Within 24 hours, you will receive an email with a post-event survey
  3. Complete the survey correctly and receive an email with your certificate of completion within one week

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Join Our Three-Part Series

Part 1: July 31, 2025

Part 2: August 21, 2025

Part 3: September 25, 2025

2:00 p.m. EST for all three events

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Presenter(s)


Donna Malone, CPC, CRC, CRC-I, RISE Fellow, AHCCA, RAP

Director of Risk Adjustment, Mass General Brigham

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, RISE Fellow, is Director of Risk Adjustment at Mass General Brigham, Adjunct Professor at MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group, content developer RISE designations and workshops, and 2025 Member Development Officer New Bedford, MA AAPC chapter. She has 29+ years’ experience (payer, provider system and vendor) in healthcare with primary focus on value-based care. Donna speaks nationally for RISE, AAPC and AHIMA.

Jeannie Hennum

General Manager of Value Based Care, Verisma

Jeannie Hennum, General Manager of Value Based Care at Verisma, has 25+ years of experience focused on payers and providers in medical record retrieval, release of information (ROI), risk adjustment, quality measures, and claims adjudication. Previously, she was CEO at ChartFast, developing relationships with health systems and plans, and automating the request and delivery of medical information between those parties.

Amy Derlink, RHIA, CHA, CHPS

Director of Compliance and Privacy, Verisma

Amy Derlink, RHIA, CHA, CHPS, is Director of Compliance and Privacy at Verisma. She’s responsible for evaluating, developing, implementing, maintaining and ensuring adherence to policies and procedures related to patient information privacy and security. Amy earned her bachelor of applied science (BASc) in health information management from University of Pittsburgh.

Elizabeth McElhiney, MHA, CPHIMS, CHPS, CDH-L, CRIS, CC

Director of Government Affairs and Policy, Verisma

Elizabeth McElhiney, MHA, CPHIMS, CHPS, CDH-L, CRIS, CC, serves as Verisma’s Director of Government Affairs and Policy. In this role, she partners closely with clients to navigate evolving regulatory and legislative landscapes at the state and federal levels. Elizabeth leads the implementation of evidence-based best practices and oversees the company’s thought leadership strategy. She also serves as Legislative Affairs Chair at the Alliance for Health Information Operations and Standards (AHIOS). Elizabeth holds a Master of Health Administration with a specialization in Health Informatics from Capella University and a Bachelor of Arts in Political Science from Illinois Wesleyan University.

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