The Centers for Medicare and Medicaid Services (CMS) conduct mandatory Risk Adjustment Data Validation (RADV) audits to verify that the data submitted by Medicare Advantage Organizations (MAOs) to CMS for payment purposes are appropriately supported in a valid medical record.
As an MAO, HPSM is required to collect, review and submit medical records to CMS to validate data used for payment purposes. To support this process, HPSM may request medical records from provider offices. Network providers’ participation in sharing medical records for all regulatory audits is mandatory.
If you receive an RADV-related notice of medical record collection from HPSM, please deliver the medical records by the identified deadline, as CMS maintains stringent audit timelines. You may get multiple RADV requests from HPSM: each will be unique from other medical record requests you have previously received from us.
If you have any questions or would like additional information about CMS RADV audits, please email [email protected].