With the passing of the Affordable Care Act commercial health plans are now required to participate in a relatively unknown type of audit known as a Risk Adjustment Data Validation (RADV) audit. Nearly all health plans will be required to perform these audits and because it is a newer process, many health plans may not fully understand what these audits consist of and require.
RADV audits require that a plan gather data and report on 200 plan members from each state. Once the CMS provides the list of sample members, health plans are responsible for gathering all of the patient data and medical records that will be needed to validate the risk score for each member. With Datafied’s RADV services, we will identify which medical records will provide the best results for each member and we then go and collect this data. Once the critical data has been secured, Datafied’s professional coders thoroughly examine each chart and produce codes to validate members’ conditions.
We will work very closely with your health plan throughout the process, providing you with regular updates on our progress and findings. Before any information is submitted to CMS, we review our work for accuracy and then provide the results to your plan so that you are able to verify that all of the necessary information is being presented.
Datafied has successfully handled audit projects for over 30 years and we have extensive experience working with CMS. Let us handle your RADV project and the following dispute resolution process to ensure that all of the proper data is submitted in a timely manner, enabling your plan to successfully meet the RADV audit requirements.