Risk Adjustment Data Validation (RADV) Audit Training Practice Test 2025 – All-in-One Guide to Master Your Audit Training!

A best medical record for a RADV audit is characterized by its thoroughness and comprehensiveness. The correct answer highlights the importance of documenting not only the Hierarchical Condition Categories (HCCs) requested by the Centers for Medicare & Medicaid Services (CMS) but also the necessity of meeting all required documentation elements. Additionally, it emphasizes that the record can include extra HCCs that were not initially requested by CMS, demonstrating a more complete understanding of the patient's health status.

In RADV audits, the support for HCCs is critical, as these codes affect payments and health plan risk adjustment. Therefore, a medical record that meets these criteria stands as a best practice, because it ensures that patient data is comprehensively represented, allowing for accurate validation of risk adjustments. The inclusion of additional HCCs signifies a proactive approach to capturing the patient's full range of diagnoses, which can be beneficial for both clinical care and financial aspects of care funding.

While other options present valid situations regarding the validation of HCCs, they either lack completeness, such as missing signatures or failing to include unrequested HCCs, which do not align with best practices during a RADV audit. This highlights the important distinction in documentation quality necessary for a robust RADV audit