The Fear of RADV Audits Ends Here.
MedChartScan provides an unbreakable link between every diagnosis, claim, and medical record, giving providers and health plans a shared source of truth for risk adjustment.
A Simple, Shared Source of Truth
Claim Submitted
A claim with an HCC diagnosis is sent through your standard billing process.
Evidence Linked
MedChartScan automatically attaches the accepted AI suggestion and the supporting clinical documentation from the patient's chart.
Instantly Verifiable
Both the provider and the contracted health plan can view the claim and its supporting evidence in a secure, auditable log.
Want to explore the full story behind our new module? Read the official announcement post for a deeper dive into our philosophy on compliance and collaboration.
For Providers
Reduce Audit Anxiety
Face RADV audits with confidence, knowing every code is backed by linked, accessible evidence.
Eliminate Manual Prep
Stop wasting hundreds of hours on manual chart chasing. Generate comprehensive audit packages on demand.
Strengthen Payer Relationships
Build trust with health plans through a shared, transparent view of clinical documentation.
For Health Plans
Gain Unprecedented Visibility
Securely verify the clinical evidence behind HCC claims without disruptive, manual record requests.
Ensure CMS Compliance
Partner with providers to build a compliant, data-driven ecosystem that satisfies CMS requirements for data integrity.
Reduce Provider Friction
Move from an adversarial audit process to a collaborative partnership, reducing disputes and administrative burden.
RADV audits, in brief
What CMS validates, who gets sampled, and where extrapolation stands after the 2023 rule. The full guide sets out each rule with its CMS, Federal Register and OIG source.
What CMS checks
That every diagnosis paid for risk adjustment is documented in a face-to-face encounter record from an acceptable provider, with a valid signature. Certified coders read each record, with up to three independent reviews.
Who gets sampled
Enrollees from the top quartile of CMS's improper-payment models, 35 to 200 per contract depending on its size. The PY2024 record window runs September 18, 2026 to February 5, 2027.
Where the money stands
The 2023 rule set extrapolation from PY2018 and no fee-for-service adjuster. A federal court vacated it in September 2025; CMS has appealed and, for now, collects only the errors found in sampled enrollees.
What a reviewer tests the record against
Eight rules from CMS's reviewer guidance, audit methods, appeal guidance and OIG's 2026 compliance guidance.
- 01Every submitted diagnosis traces to a record of a face-to-face encounter
- 02The record comes from an acceptable provider type and specialty
- 03The date of service falls inside the data collection period
- 04The signature carries a name, credentials and a date within 180 days of the encounter
- 05Telehealth encounters used interactive audio and video
- 06The "one best" record for each HCC is identified before the audit, not during an appeal
- 07Chart reviews run in both directions
- 08The 60-day appeal clock and the HPMS contact list are ready before the notice arrives
70%
of the high-risk diagnosis codes in the HHS Office of Inspector General's Medicare Advantage audits were not supported by the medical record, in the toolkit OIG published in December 2023. Some codes were unsupported more than 90 percent of the time.
RADV questions
Move from a Defensive Posture to a Confident Partnership.
The future of risk adjustment is not about fearing audits; it's about being perpetually ready for them. MedChartScan provides the shared source of truth to make it happen.
Schedule Your Live Demo
See our AI on your charts in a focused 30-minute working session — no commitment. We'll show your RAF & revenue lift, the claim-to-evidence audit trail, and how fast you go live.
✓ 30 minutes✓ No commitment✓ See your own numbers
