Certified Risk Adjustment Coder (CRC)

What should a RADV audit focus on regarding medical records?

1. Availability of electronic records only

2. Completeness, legibility, and provider identification

3. Records should be outdated and irrelevant

4. Provider identification is optional

The correct answer is: Completeness, legibility, and provider identification

The focus of a RADV (Risk Adjustment Data Validation) audit on medical records should include assessing the completeness, legibility, and provider identification. This is essential because the accuracy and validity of the risk adjustment process heavily rely on the quality of the medical documentation. Completeness ensures that all necessary information is present to support diagnoses and medical claims. This includes documenting all relevant patient encounters, diagnostic information, and treatment plans that were provided during the year in question. Legibility is crucial for external reviewers to understand the provided information. If the records are difficult to read, it can lead to misunderstandings about the patient's health status and treatment, potentially affecting the risk scores and reimbursement processes. Provider identification ensures that the documentation is authenticated by a qualified healthcare provider. This verification helps uphold the integrity of the medical records, as each entry in the record must be traceable back to a responsible practitioner to confirm the services rendered and their justification. In summary, focusing on these three aspects during a RADV audit helps ensure that the data used for risk adjustment is accurate, reliable, and maintains the integrity necessary for proper healthcare reporting and reimbursement.