CMS Releases RADV Methodology; 30 Annual MA Audits Expected

The Centers for Medicare & Medicaid Services Feb. 24 released the methodology for calculating errors in audits of Medicare Advantage plan payments, saying it expects to audit about 30 MA contracts annually.

The next round of risk adjustment data validation (RADV) contract-level audits will be based only on payment year 2011, CMS said.

“New audits of Medicare Advantage contracts will reduce the payment error rate for the Medicare Advantage program and will recover an estimated $370 million in overpayments for the first audit year,” CMS said in an accompanying statement.

The RADV audits allow the government to attempt to confirm ...