CMS conducts annual RADV audits to ensure risk-adjusted payment (HCC) integrity and accuracy. The purpose is to identify any payment errors by having the MA organizations and their corresponding providers to submit specific requested medical records to validate the risk adjustment data or HCCs. So if a specific claim is included in the RADV audit, and it has a code for say, Diabetes Type 2 E11.9, they will review the chart note to see if it was appropriately documented. An errors can result in funds being returned to CMS. This document list the specifics around RADV audits. The latest RADV Medical Record Guidance For auditing commencing after 01/10/2020, Version 2.0 https://cms.gov/files/document/medical-record-reviewer-guidance-january-2020.pdf https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/Coders_Guidance.pdf RADV Medical Record Reviewer Guidance ========================= Prior guidance on audits commencing after 09/27/2017 'Contract-Level Risk Adjustment