Medical Economics October 23, 2025
Strategies for organizations to navigate CMS’s decision to fast-track risk adjustment audits.
The U.S. Centers for Medicare & Medicaid Services (CMS) has announced it will expedite risk adjustment data validation (RADV) audits on all Medicare Advantage (MA) contracts each year. This year will be an especially interesting one as the agency works through a seven-year backlog (2018 to 2024) to bring the program up to date. Notably, CMS will also be extrapolating findings of the expanded (but still relatively small) sampling they will perform for each contract.
These changes mark a turning point for MA plans: The old model of retrospective risk management is no longer sustainable. Proactive coding practices, are essential for navigating this new reality.
As with most...
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