Simplify RADV audits. Protect your revenue.
Built for the new RADV era
Strengthen your Medicare Advantage compliance and revenue protection as RADV audits evolve. Reveleer’s RADV Audit Solution combines AI-powered retrieval, intelligent coding validation, reduced errors, and audit defensibility.
Defensible CMS audit response
Full workflow traceability ensures you can defend every HCC and every chart.
Automated provider pursuits
Simplify provider outreach with intelligent workflows that drive faster resolution.
Evidence ranking reports
Rank supporting medical records to highlight the strongest evidence for submissions.
RADV audit readiness checklist: 6 tips for payers
CMS is raising the bar on RADV audits. Get audit-ready with these six essential tips for navigating the process. Learn how health plans can strengthen compliance, improve documentation, and avoid costly errors through proactive planning and smarter data management.
Our 5-step RADV audit workflow
From data ingestion to CMS submission, streamline each step of the RADV audit for faster, more reliable outcomes.
CMS Enrollee Data List Ingestion
Automated import, validation, and preparation for CMS enrollee data.
Record Chasing & Retrieval
AI-powered targeting and follow-up for complete, accurate member documentation.
AI/NLP Coding Review
EVE™ validates HCCs per payment year, closing compliance gaps.
Provider Attestation & QA
Simplify attestation requests, multi-level coding QA checks, and get real-time visibility.
Audit Submission Package
Efficient, CMS-ready digital packaging for on-time, defensible audit response.
Key benefits of Reveleer's RADV Audit Solution
Accelerated medical record retrieval
Leverage advanced automation to locate, request, and retrieve high volumes of records up to 80% faster than manual workflows. Reveleer's record retrieval matches every document across current and legacy systems, multiple years, and different provider networks to the correct audited enrollee, so no chart is left behind.
AI-driven HCC validation
Reveleer's proprietary Evidence Validation Engine (EVE™) suggests and maps diagnoses to the correct HCCs with up to 99% accuracy. EVE instantly reviews medical documentation, catching unsupported conditions before CMS does, minimizing your extrapolated repayment risk.
Simplify provider attestations and submissions
From automated outreach and tracking of provider attestations to creating CMS-ready submission packages, Reveleer takes the complexity out your MA RADV projects. Track documentation and audit readiness for every contract, with always-on platform project visibility and reporting.
Quality assurance, from sample to submission
Mitigate financial exposure with multi-level QA, coding overreads, and audit logs, ensuring defensible, compliant submissions. Built-in validation alerts coders to potential issues so that errors are corrected before submission, not after an audit.
Article
CMS expands RADV audits. Are you prepared?
With CMS implementing annual RADV audits for all Medicare Advantage plans and using advanced technology to identify unsupported diagnoses, compliance expectations are rising fast. Health plans face growing pressure to strengthen documentation, retrieval, and validation processes. Explore what the new audit requirements entail and discover strategies to stay ahead of CMS scrutiny.
The Reveleer Platform
Accelerate value-based care outcomes with AI
Improve accuracy and the predictive power of your data with AI-powered healthcare solutions.
The basics of CMS's RADV audits
What is a RADV audit?
A RADV audit is an annual process mandated by CMS for all Medicare Advantage plans. It requires plans to validate the accuracy of diagnosis codes submitted for risk adjustment payments. RADV audits exist to ensure compliance and data integrity, and there are significant financial risks if errors are found and extrapolated across contracts.
What are the recent changes in RADV audit requirements?
In May, CMS introduced changes to the RADV program that require expanded audits with larger sample sizes (up to 200 members per contract) and look-back periods covering multiple years (records dating back to 2018). Read more about the recent RADV updates on our blog.
How does automation help in the RADV audit process?
Automated RADV audit solutions streamline workflows through project data ingestion, multi-channel medical record retrieval, AI-powered coding and QA, and provider attestation management. The result is faster processing, cost savings, and higher submission accuracy so that health plans can gain peace of mind when it comes to risk adjustment compliance.
What happens if a health plan fails a RADV audit?
Plans may face significant financial recoupments if error rates identified in the audited sample are extrapolated across the entire contract. Early preparation is critical to reducing operational disruption and minimizing financial risks.
Are Reveleer’s technology solutions CMS and HIPAA-compliant?
Yes, the entire Reveleer platform is compliant with CMS, HIPAA, and other regulatory bodies. We designed our platform workflows to align with CMS requirements, and our team keeps a close eye on the ever-evolving regulatory landscape to ensure processes from data acquisition to CMS submissions meet the highest regulatory standards.
What other solutions does Reveleer provide to support success in value-based care?
In addition to our powerful Risk Adjustment suite, Reveleer offers a single platform for value-based care that incorporates Quality Improvement, Clinical Intelligence, and health plan Member Management technology suites.
Related Resources
Learn how AI-powered healthcare technology can make all the difference in increasing speed and accuracy.
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