Certified Risk Adjustment Coder (CRC)

How many records must health plans submit per patient in a RADV audit?

1. One

2. Five

3. Ten

4. None; it is based on claim data

The correct answer is: Five

In a RADV (Risk Adjustment Data Validation) audit, health plans are required to submit a total of five medical records per patient. This is to ensure a comprehensive review of the patient's medical conditions and the accuracy of the diagnosis coding. By requesting multiple records, auditors can verify that the reported diagnoses accurately reflect the patient's health status and adherence to coding guidelines. This approach enhances the integrity of risk adjustment efforts and ensures that the data submitted aligns with the patient's clinical documentation, ultimately supporting appropriate reimbursement based on the patient's true health condition.