CMS Risk Adjustment Data Validation (RADV) Practice Exam

RADV audit process focuses on risk adjustment data and payer reimbursement. The audits verify that the diagnosis information used to generate risk scores is accurate and supported by medical records, because those scores determine how much a payer is reimbursed. In Medicare Advantage, data like diagnoses feed a risk adjustment model (such as CMS-HCC), and any errors or unsupported codes can lead to incorrect payments. The goal is to ensure payments reflect the true health status of enrollees, not to assess laboratory results, pharmacy benefit design, or medical device procurement.