Code accurately. Document defensibly. Stay audit-ready.
Every diagnosis that raises a risk score has to be supported by the medical record. As audit and oversight activity increases across Medicare Advantage and other risk-bearing programs, we validate charts against claims, find the exposure before an auditor does, and help you defend what you have coded.
What is a RADV audit?
A Risk Adjustment Data Validation (RADV) audit is how CMS confirms that diagnosis codes submitted for risk adjustment are actually supported by the medical record. If a chart cannot support a coded diagnosis, that diagnosis, and the payment tied to it, can be reversed.
Find the exposure before an auditor does.
Every diagnosis that raises a risk score has to hold up against the medical record. These are the capabilities that keep it defensible.
Chart validation.
Chart validation compares claims against the medical record, identifying where a coded diagnosis lacks sufficient documentation before an external reviewer would flag it.
MEAT and ICD-10 review.
MEAT criteria (Monitor, Evaluate, Assess, Treat) confirm a condition was actually managed at the visit, not just listed. ICD-10 specificity review confirms each code is documented to the level of detail it requires.
Unlinked charts risk.
An unlinked chart is documentation that exists but is not properly connected to the claim it is meant to support, creating audit exposure even when the underlying record is otherwise complete. We identify and remediate that gap.
Pre-audit detection.
Pre-audit detection and audit simulation model how an actual RADV review would sample and evaluate your charts, surfacing likely findings before CMS or a plan conducts one.
Risk mitigation.
Financial and compliance risk mitigation quantifies potential repayment exposure from unsupported diagnoses, so it can be addressed before an audit turns it into an actual liability.
Performance intelligence.
Performance intelligence across providers, groups, and plans surfaces patterns in documentation quality at each level, so a systemic issue does not read as a series of isolated cases.
Powered by direct CMS data access and proprietary infrastructure built over years.
Chart validation is checked against the full claims history, not partial data, using infrastructure we built and maintain ourselves.
Built for Medicare programs and other risk-bearing entities.
Audit exposure follows wherever CMS validates risk adjustment data. The same infrastructure applies across programs.
Built for RADV exposure.
Audit-ready coding review for Medicare Advantage (Part C) plans, using the same infrastructure described above. RADV audits originated with, and remain most consequential for, Medicare Advantage risk adjustment.
- Chart validation against Part C encounter data
- Same MEAT criteria and ICD-10 specificity review
- Directly addresses RADV exposure, which applies specifically to MA risk adjustment
Medication documentation matters too.
Part D claims help confirm that medication-driven diagnoses have supporting documentation, not just medical claims alone.
- Cross-checks medication history against coded conditions
- Useful alongside medical claims, not a replacement for them
- Supports defensibility for complex, high-needs patients
Pairs with risk adjustment.
Audit readiness and risk adjustment are complementary services built on the same infrastructure.
- 14-year lookback compared to the standard 3
- Suspect identification and recapture strategy
- Learn about Risk Adjustment
Let's talk about your audit exposure.
Tell us about your program and we'll walk through what this looks like for your organization.