Certified Risk Adjustment Coder (CRC)

What defines a best medical record for a RADV audit?

1. Documentation that validates all requested HCCs

2. Documentation validating the CMS requested HCCs with necessary elements and an additional HCC

3. Documentation validating requested HCC without provider signature

4. Documentation with signed CMS attestation but missing provider signature

The correct answer is: Documentation validating the CMS requested HCCs with necessary elements and an additional HCC

The best medical record for a Risk Adjustment Data Validation (RADV) audit is defined by documentation that not only validates the Centers for Medicare & Medicaid Services (CMS) requested Hierarchical Condition Categories (HCCs) but also includes all necessary elements along with the documentation of an additional HCC. This comprehensive approach ensures that it meets the stringent requirements established by CMS for validating risk adjustment factors. In the context of an audit, the integrity and completeness of the documentation are critical. Validation of requested HCCs means that the medical records must support the conditions that contribute to risk adjustment, demonstrating the clinical accuracy of the diagnoses coded. By including all necessary elements, such as test results, physician notes, and treatment plans, and adding an extra HCC, the documentation strengthens the audit support, showing a more accurate picture of the patient's health status and care needs. This thoroughness is essential because accurately accounting for all relevant HCCs can impact reimbursement and compliance. Other options lack the comprehensive nature of documentation required for the best medical record in a RADV audit. For example, some documentation may only validate selected HCCs or lack the necessary provider signatures, which are paramount for confirming the legitimacy of the medical record. Properly signed documentation assures auditors that the