CMS Temporarily Suspends Contract-Level RADV Audits

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 15th, 2020

On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced to all of the Medicare Advantage Organizations and Part D Sponsors that effective immediately, it is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. 

This is another example of how the federal government is trying to ease the burdens of providers and payers tasked with the main responsibility of providing healthcare and coverage, respectively, for hundreds of thousands of U.S. citizens affected by COVID-19. However nice this temporary reprieve may be, it is vital to remember that it is only temporary and that the auditing work of CMS will not completely come to a screeching halt.

The CMS notice reminds us that although there is a temporary reprieve for the 2015 audit, they will continue to allow payers to submit medical documentation they have already received from providers. CMS will also review any of the medical records already submitted or that will be submitted for the 2014 audit. Because of this, CDAT will remain open for record submission and payer feedback. 

Although CMS is not beginning any new audits, it is important to realize they now have a little more time to scrutinize the records they do have, especially for the 2014 audit, so be sure to watch for organizational feedback that may be a bit more detailed or refined that has been in the past. As a payer organization, take the time to fortify compliance plans, education, and to carefully review the feedback CMS sends to your organization and apply it towards the 2015 audit that will begin after the current crisis has abated. Be sure to take advantage of the many tools and resources available in HCCCoder.com to prepare for when the temporary suspension is lifted. 

For additional information related to contract-level RADV audits, contact CMS at RADV@cms.hhs.gov.

About Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Aimee L. Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. Aimee believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.