News Briefs: CMS Issues RADV Audit Notices to 355 Medicare Advantage Contracts
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Jul 03, 2025
CMS has notified more than 60% of active Medicare Advantage contracts of their selection for risk adjustment data validation (RADV) audits to confirm the accuracy of medical diagnoses submitted for payment year 2019. CMS in May unveiled its plans to rapidly scale RADV audits, eventually expanding its annual audit capacity by more than 800% to cover approximately 550 MA contracts. According to a question-and-answer document updated on June 25, CMS in June notified 355 contracts of their selection and expects to begin issuing audit findings by early 2026. Those audits will focus on “risk adjustment payments…that CMS believes may be at higher risk for overpayments,” and CMS will select samples of enrollees within the audited MA contracts and request medical records for those enrollees to confirm that the diagnoses submitted by the MA organizations for risk-adjusted payment are supported by medial record documentation.
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