Program History

Risk Adjustment Data Validation

The Centers for Medicare & Medicaid (CMS) conducts risk adjustment data validation (RADV) to ensure the accuracy and integrity of risk adjustment data submitted for Medicare Advantage (MA) risk adjustment payments. RADV is the process of verifying that diagnosis codes submitted for payment by an MA organization are supported by medical record documentation.

There are two major RADV activities that CMS conducts:

• Contract - Level Samples
• National Sample

The Contract - Level Samples are used to conduct payment recovery from MA organizations. The National Sample is used for annual payment error reporting. For additional information on payment error reporting, follow the below link. /Medicare/Medicare-Advantage/Plan-Payment/PaymentValidation

The information contained on this page pertains to the payment recovery audits.