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Wiki Risk Adjustment Audits

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Vrdurden

Networker
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Tavares, FL
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We are bombarded with Risk Adjustment Audits. I've been working on one asking for medical records for 500+ charts. Has anyone actually been penalized for not completing and if so, what are the repercussions?

Vicki Durden,CPC
Lake Eye Associates
 
Risk adjustment audits

We always send the requested records for a RADV audit, regardless of how many.

I have been told by others that Providers are not required to send the records.

However, I have been unable to find anything official that confirms that.

I would send all records requested unless you can find documentation stating that you do not have to.

Good luck
 
records request

Your office needs to comply with requests for medical records.

The plan is being audited to validate conditions that were billed for its members (YOUR patient).

The plan is subjected to financial penalties if they are unable to prove conditions for members that are part of the audit. It is considered an error, as CMS does not differentiate between reasons why a condition is not supported (no records, or billing error).

The plan paid your claim, and should have rights to the medical record that supports the condition that was billed by your office.
 
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