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Stop RADV Audit Surprises Before They Start

Know exactly where your risk adjustment program is heading with these steps toward audit readiness.

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THE CHALLENGE

Navigate the New, Ongoing RADV Season With Precision

In January 2026, CMS announced an update on the status of Medicare Advantage (MA) RADV audit rules, which clarified the 2025 audit expansion notice while raising the stakes.1 The biggest impact on MA plans will come in the form of:

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Increased Admin. Burden: Plans must now manage a regular “cadence” of future audits every three months – increasing from once a year.
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Recovery Pressures: Recoveries from Plan Year (PY) 2011-13, which found overpayment rates of 5% to 8%, are set to “begin soon.”
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Strict Documentation Limits: CMS has reduced the maximum number of medical records allowed per audited HCC from five to two.

CMS’s RADV audits are no longer just a compliance checkpoint – they’re a strategic imperative requiring permanent staffing or specialized vendor support. Fortunately, there is a way to gain full visibility into your RADV strategy.

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Every 3 Months

The cadence of future RADV audits, starting with PY 2020 audits in Feb. 2026.1

5% to 8%

Overpayment rates found by CMS for PY 2011-2013. Recoveries on these amounts are set to begin “soon.”1

From 5 to 2

The maximum number of medical records allowed per audited HCC.1

Confident Compliance Starts Here

A clear plan is the fastest way to turn RADV audit uncertainty into readiness. Use this checklist to map your path forward, starting now.

How to Proactively Prepare for a RADV Audit

  • A blue outline icon of a document with horizontal lines, representing text, and a magnifying glass with a checkmark inside, symbolizing review or approval for Healthcare Risk Management & Reporting Software.

    Task 1

    Set up a compliance program

  • A blue outline icon shows three user profile symbols, with a hand icon pointing to the top right profile, suggesting staff scheduling or selection among users.

    Task 2

    Establish a dedicated coding team

  • A simple blue line icon showing three stacked documents with lines representing text and a gear symbol in the lower right corner, against a light gray background.

    Task 3

    Create clear coding documentation guidance for partners

  • A blue outline of a shield with a padlock in the center, surrounded by circuit-like lines, symbolizing cybersecurity or digital protection for real-world data.

    Task 4

    Choose an advanced over-coding surveillance technology partner

If you’re ready to stop audit surprises before they start, then Inovalon is ready to be your guide.

RADV Resources

Gain insights and perspectives from Inovalon’s experts with our latest RADV articles, white papers, webinars, and more.

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Mastering Medical Record Reviews With AI

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5 Strategies for an Effective Risk Adjustment Program

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Proactive CMS RADV compliance: Identify potentially over-coded conditions early on

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Inovalon’s Risk Adjustment Solutions

Improve compliance with advanced analytics, flexible member engagement solutions, and efficient, accurate documentation of member conditions.

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Converged Risk™

Uncover more gaps efficiently and ensure your population’s risk burden is accurately reflected.

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Converged Submissions™

Deliver complete, accurate, secure, and timely submissions with fewer errors for Medicare EDS and ACA EDGE Server.

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1 Update on the Status of Medicare Advantage Risk Adjustment Data Validation Audits,” Steven Ferraina, The Centers for Medicare & Medicaid Services,” January 27, 2026

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