CMS Risk Adjustment Data Validation (RADV) Practice Exam

What is the main objective of postpayment RADV?

To determine plan premiums. To validate data after payments have been made. To validate data before payment. To reduce the overall RAF automatically.

Correct Answer:

To validate data after payments have been made.

Explanation:

Postpayment RADV is about validating the risk adjustment data after payments have already been issued. The goal is to verify that the diagnoses and other data used to calc the risk adjustment factors and corresponding payments are accurate and properly supported by medical records. If issues are found, adjustments or recoveries may follow, rather than changing payments upfront. This is different from prepayment RADV, which aims to catch problems before money flows. It does not determine plan premiums and it does not automatically reduce the RAF; the focus is on ensuring data accuracy after payments have been made.

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