CMS Risk Adjustment Data Validation (RADV) Practice Exam

What is the difference between encounter data and chart documentation in RADV?

Chart documentation is the data submitted in claims about patient encounters; encounter data are the actual medical records used to validate diagnoses. Encounter data are data submitted in claims about patient encounters; chart documentation is the actual medical records used to validate diagnoses. Encounter data refer to patient surveys; chart documentation refers to physician notes. They are interchangeable terms.

Correct Answer:

Encounter data are data submitted in claims about patient encounters; chart documentation is the actual medical records used to validate diagnoses.

Explanation:

In RADV, two sources of evidence are used to validate diagnoses on submitted claims: encounter data and chart documentation. Encounter data are the data submitted in claims about patient encounters; chart documentation is the actual medical records used to validate diagnoses. The encounter data provide billing-level information—the codes, dates of service, and provider details that feed into risk scores—while chart documentation offers the clinical proof that those codes are accurate and supported by the patient’s records, notes, tests, and findings. If the chart documentation does not support a diagnosis listed on the encounter data, the diagnosis may be disallowed or adjusted.

Access more questions from this quiz

Continue to CMS Risk Adjustment Data Validation (RADV) Practice Exam for more practice questions and the full quiz experience.

Access More Questions