CMS 2025 RADV audit expansion: Key changes and what they mean to MA plans
In a significant move announced on May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) revealed plans to initiate annual Risk Adjustment Data Validation (RADV) audits for all Medicare Advantage (MA) plans. In this memo, CMS Administrator, Dr. Mehmet Oz, is quoted as saying “We are committed to crushing fraud, waste and abuse … CMS 2025 RADV audit expansion: Key changes and what they mean to MA plans
How to choose the right risk adjustment vendor
Executive Summary Choosing a risk adjustment vendor should never be reduced to coding function alone. The right platform should improve documentation quality, integrate into clinical and operational workflows, provide transparent analytics, support prospective and retrospective programs, and maintain audit readiness. Organizations should prioritize configurable technology, explainable AI, strong governance, measurable outcomes, and an implementation approach … How to choose the right risk adjustment vendor
