CMS Makes Significant Updates to and Expands Scope of Medicare Advantage RADV Audits
This Feature Article is brought to you by AHLA's Payers, Plans, and Managed Care Practice Group
- September 05, 2025
- Tyler Marshall , Berkeley Research Group
On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its primary auditing tool used for Medicare Advantage (MA) plans or contracts. CMS conducts Risk Adjustment Data Validation (RADV) audits to help ensure the accuracy of payments based on the health status of Medicare beneficiaries in the MA program. These audits involve reviews of enrollee medical records to determine if diagnoses submitted for payment purposes have the appropriate documentation support in accordance with industry guidelines.
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