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Policy Primer

2024 Risk Adjustment Data Validation final rule

CMS issued the 2024 Risk Adjustment Data Validation (RADV) final rule, outlining changes to the audit process for Medicare Advantage Organizations. Learn the biggest implications of the rule and how it will affect health plans over the next three years as CMS phases in new risk models.
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INTENDED AUDIENCE
  • Health plans
AFTER YOU READ THIS
  • You should evaluate and recalibrate internal projections for the next three years of CMS’ phased-in risk model.
  • You should Improve data capture and tracking throughout the enterprise and within provider network.
  • You should consult with finance teams to project and prepare for any budget challenges.
  • You should ensure adequate staffing and resources to educate and adapt to ongoing policy changes.
  • You should monitor and educate providers at risk of coding incorrectly.
AUTHORS

Chelsea Needham

Consultant, Health plan research

Mallory Kirby

Director, Health plan research

Posted on June 20, 2023

Updated on December 29, 2023

TOPICS
Health Plan Medicare Advantage Policy and Payment
INDUSTRY SECTORS
Health Plans

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