Expert RADV Audit Support for Medicare Advantage Plans

Lay the groundwork for a successful RADV audit with a proactive assessment of your data and documentation. Our pre-audit services help identify risk areas, flag suspect records, and ensure your team is aligned with CMS HCC model requirements.

• Retrospective Risk Assessment: Analyze historical encounter and claims data to identify unsupported HCCs or patterns of over/under-reporting.

• Suspect Identification:Use analytics to flag members at risk of being selected in the audit sample.

• Audit Readiness Checklist: Assess documentation completeness and coding practices against CMS HCC model requirements (e.g., MEAT criteria).

Efficient and accurate chart retrieval is critical to audit success. CSI streamlines the process with coordinated workflows, ensuring timely access to complete and well-organized medical records.

• Record Retrieval Coordination: Establish efficient retrieval workflows (electronic, provider outreach, EMR access).

• Document Indexing: Organize medical records with clear labeling of dates of service, provider info, and source documentation.

Our certified coding and clinical experts deliver real-time quality assurance, education, and KPI monitoring to ensure your documentation meets CMS standards and withstand audit scrutiny.

• Services: Provide status check-ins, single contact, crisis plan, and project monitoring.

• Continued Support: Deliver real-time quality checks, ongoing education, initial assessments, and KPI remediation

Explore our full suite of medical coding compliance and auditing solutions, including managed coding services and staff augmentation, by clicking here.

From formatting to final submission, we manage every detail to ensure your audit response is accurate, timely, and compliant. If discrepancies arise, we’re ready with appeal support backed by clinical and regulatory expertise.

• File Preparation: Ensure documentation meets CMS requirements for format and content.

• Audit Response Management: Track and submit documents within CMS timelines (usually 30-45 days).

• Appeal Preparation: If discrepancies are flagged, prepare appeal packages with medical and regulatory justification.

After the audit, we help you interpret CMS findings, model financial impact, and implement corrective actions. Our goal is to reduce future risk and maintain continuous RADV readiness through ongoing monitoring and mock audits.

• Audit Result Analysis: Review CMS findings and compare against internal reviews.

• Financial Impact Modeling: Quantify potential payback exposure or risk score impact.

• Corrective Action Plans (CAPs): Implement training, workflow, and documentation improvements to prevent repeat issues.

• Ongoing Monitoring: Establish regular internal RADV simulations or mock audits to maintain readiness.