Risk Adjustment Audits For Medicare Part C – Review of Ophthalmology

Knowing what to expect from a Risk Adjustment Data Validation audit will help to prevent easily avoidable errors.

This article addresses the following questions:

  • Does Medicare Part C function in the same manner as Medicare Part B?
  • Is beneficiary enrollment in Medicare Advantage plans growing?
  • Who pays private insurance companies to manage Part C plans?
  • How do the plans collect data on an individual patient?
  • How does CMS determine the accuracy of the risk-adjusted payments they make to the managed-care plans?
  • Who provides the information to the Advantage plan for submission to CMS when the plan is audited?
  • Should we assume that any records request from an Advantage plan is for a RADV audit?
  • Do I need patient consent to release medical records for a RADV audit?
  • How many records are requested by the plan to satisfy a RADV audit?
  • What types of errors are found during a risk adjustment audit?
  • Will the ICD-10 coding system improve the data submitted to CMS?
  • Should we include patients with Medicare Advantage plans in our internal and external chart review process?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:


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