Certified Risk Adjustment Coder (CRC)

When submitting documentation for RADV/IVA, what is the protocol for records?

1. Single DOS for outpatient and full hospital record

2. Single DOS for both outpatient and inpatient records

3. Full outpatient record and partial inpatient records

4. Documentation can be condensed into a summary

The correct answer is: Single DOS for outpatient and full hospital record

The correct approach when submitting documentation for Risk Adjustment Data Validation (RADV) and Independent Validation Audit (IVA) is to provide a single Date of Service (DOS) for outpatient and a full hospital record. This means that for comprehensive audits, it is essential to include all relevant information related to the outpatient visit as well as the full inpatient stay. Ensuring that the documentation is complete and contains detailed clinical information increases the likelihood that the submitted data accurately reflects the patient's condition and the services rendered. Providing a full hospital record allows auditors to assess all aspects of inpatient care, including diagnoses, treatments, and any comorbidities or complications that may not be evident from outpatient records alone. This thoroughness is crucial as it supports the risk adjustment process by enabling accurate coding and helps ensure compliance with regulations. In contrast, the other options suggest incomplete or insufficient documentation practices, which could lead to misunderstandings or inaccuracies in the auditing and risk adjustment processes. Proper documentation is critical in defending the submitted claims against potential audits.