What CMS Pulls in a RADV Audit

Your Medicare Advantage contract gets a RADV notice. A list of patients arrives, each with a list of HCCs, and your team has a few months to find the records that prove every one of them. Which patients did CMS pick, and why those? What records will CMS accept, and which ones will it throw out before a coder reads a word? In this video I cover how CMS selects RADV samples now that it audits every eligible MA contract, the cap on how many records you can submit for each patient, which record sources are valid and invalid, the checklist CMS reviewers use, when a CMS-Generated Attestation can fix a missing signature, how the three rounds of coder review work, your 60-day appeal deadlines, and where the extrapolation lawsuit stands. FREE DOWNLOAD: Request the one-page "RADV Record Readiness Checklist" through the contact form at http://help4docs.com and ask for it by name. Need help with outpatient CDI, HCC risk adjustment auditing, or physician education? Visit http://help4docs.com Sources: 1. CMS, "CMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage Audits," press release, May 21, 2025. 2. CMS, Payment Year 2020 MA RADV Audit Methods and Instructions, March 2026. 3. CMS, Payment Year 2019 RADV Audits Methods and Instructions, June 26, 2025. 4. CMS, Update on Status of MA RADV Audits (memo), January 27, 2026. 5. CMS, Risk Adjustment Data Validation Medical Record Checklist. 6. 42 CFR 422.311; CMS, MA RADV Reconsiderations Guidance, January 16, 2025. 7. Crowell & Moring, "CMS Releases PY 2020 RADV Audit Methods and Instructions: Key Takeaways for Health Plans," March 27, 2026. 8. Georgetown Health Care Litigation Tracker, Humana Inc. et al. v. Kennedy et al.; STAT News, "Judges skewer HHS arguments in hearing over Medicare Advantage audits lawsuit," October 5, 2026. About your host: Toni M. Appelberg-Parks, MBA-HM/LM, CVBA, CDEO, CDEI, CRCR, CPC, CSBI, CPPM About the creator: Toni M. Appelberg-Parks, President and Principal Consultant, Help4Docs | help4docs.com Has your organization been pulled into one of the new RADV audits? What surprised you most about the record requests? Tell me in the comments. If you have any other coding, documentation, or compliance question, drop it in the comments. I read every one. This video is for general educational and informational purposes only. It is not legal, compliance, coding, or billing advice for any specific patient, claim, payer, or organization. Coding, documentation, and regulatory requirements vary by payer and change over time, so always verify current requirements with your own organization's compliance team, legal counsel, and the applicable payer or regulatory guidance before making coding, billing, or compliance decisions. #RADV #RiskAdjustment #HCC #MedicareAdvantage #HCCCoding #MedicalCoding #ClinicalDocumentationIntegrity #CDI #HealthcareCompliance #HealthcareEducation