The Centers for Medicare & Medicaid Services (CMS) issued a rule that finalizes technical details regarding the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. This is the program that CMS uses to recover improper risk adjustment payments made to MA plans.
Final policies include:
- CMS will not extrapolate RADV audit findings for payment years 2011-17.
- CMS will extrapolate RADV audit findings beginning with the payment year 2018 RADV audit.
- CMS will not apply an adjustment factor (known as a fee-for-service adjuster) in RADV audits.
Additional information is available in a CMS fact sheet.