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Medical Record Requests for Risk Adjustment Data Validation (RADV) Surveillance Audit Program

Posted 10/12/2020 at 1:51 PM

Learn more about the coding and documentation audit coming in December 2020

In compliance with the Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) audit program, Healthfirst is required to validate the accuracy of risk adjustment data submitted for our members. Healthfirst recently implemented a RADV Surveillance Audit Program, under which the diagnoses providers report are audited to ensure that the claims information Healthfirst submits to CMS accurately reflects all conditions reported. 

Your submission of accurate and specific diagnosis claims data will help Healthfirst understand the overall health of our members. Please be sure to include the diagnosis coding of patient visits to the highest level of specificity and provide all clinical documentation necessary to support the Monitoring, Evaluation, Assessment and Treatment (MEAT) of condition(s). Timely compliance with these coding and documentation requirements will require the cooperation and assistance of staff at all levels.

Click here to learn more about what is needed for submission for the audit program.