RADV Audit Support for Healthcare Payers

Effective June 2025, the Centers for Medicare & Medicaid Services (CMS) implemented significant changes to Risk Adjustment Data Validation (RADV) audits, fundamentally shifting how Medicare Advantage (MA) plans are reviewed and held accountable. 

The most impactful change is that all eligible MA contracts will now be subject to annual RADV audits, rather than a limited sample. This move dramatically increases the compliance burden and financial exposure for plans nationwide, as CMS intensifies scrutiny on coding accuracy and diagnosis submission practices. 

RADV audits are CMS-led reviews designed to ensure that the diagnoses submitted for risk adjustment are fully supported by medical record documentation, and that plans are being paid appropriately based on member risk. 

These changes will require enhanced internal controls, increased staffing, and more robust documentation workflows to remain compliant and minimize audit risk 

Risk Adjustment & RADV Expertise That Drives Accuracy, Compliance, and Revenue Integrity

At AArete, we bring over 30 years of combined experience working with leading payer organizations to optimize risk adjustment strategy and execution. Our team understands the critical role that accurate diagnosis coding, medical documentation, and data capture play, not just in RADV audit readiness, but in driving financial performance and improving care delivery. 

Risk adjustment is the engine behind the majority of Medicare Advantage plan revenue. It enables payers to align resources with member needs, especially for vulnerable and high-risk populations. Beyond revenue, it provides a lens into member acuity, clinical outcomes, and population health management. 

We help health plans maximize compliant diagnosis capture, reduce RADV audit exposure, and build sustainable programs that support both profitability and care quality 

How We Can Support Your RADV Audit

Audit Preparation & Compliance

---

Establish best practices in audit processes, develop a data / chart retrieval playbook to ensure rapid assembly of requested documentation, train internal teams, and manage CMS-required documentation to minimize compliance risk.

Risk Adjustment Program Optimization

---

Assess and improve risk adjustment operations, reduce leakage, and provider engagement strategy to ensure accurate coding.

Financial & Strategic Advisory

---

Mitigate extrapolation risk, provide guidance on RADV financial exposure, and support bid strategy through ongoing compliance alignment 

Medical Record Coding & HCC Validation

---

Bring expert coders to validate HCCs, identify documentation gaps, and run mock RADV audits to strengthen client readiness