The March 30 memo from Centers for Medicare & Medicaid Services (CMS) informed all organizations that it is reprioritizing audit activity due to the spread of the COVID-19 virus.

That means risk adjustment data validation (RADV) audit activities related to the payment year 2015 will be suspended for Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid plans and PACE organizations. Additionally, CMS won’t initiate any additional contract-level audits until after the public health emergency is over. This suspension takes effect immediately. As a result, organizations should immediately suspend requests for provider RADV-related medical records. The suspension will be lifted once the public health emergency has ended. CMS will make an announcement when it plans to resume normal audit activities.

The Central Data Abstraction Tool (CDAT) will remain open so organizations can still submit any medical record documentation that it has already obtained to CMS.

The agency will keep the RADV mailbox and CDAT help desk open. CMS will also continue to review submitted medical records — including submissions for the 2014 audit — and will provide feedback to organizations through CDAT. For more information or questions about contract-level RADV audits, CMS asks organizations to send an email to RADV@cms.hhs.gov.

To read the full memo, click here.

Key Takeaway

Risk adjustment data validation (RADV) is the CMS process of verifying that diagnosis codes submitted for payment are supported by medical record documentation.

Confirming data accuracy can be a complex and overwhelming process. Babel Health’s solution pre-validates 100% of your encounter data, alerting you to errors prior to submission. If you’re looking to improve your approach — and prep — for future audits, now is the time to look into the Babel Health option.

The Babel Health platform works with all chart vendors so it’s easy to adopt. And unlike the chart vendors that claim they do it all or only work with scrubbed data, Babel Health empowers you to quickly and easily submit accurate, complete and compliant encounter information while identifying the revenue at risk.