HHS Risk Adjustment Data Validation (HHS-RADV) FAQ
Guidance for FAQ regarding General Audit Standards (IVA-SVA) and Other
Program Area: HHS Risk Adjustment Data Validation (HHS-RADV)
Question: Is there a crosswalk that compares the Risk Adjustment and Data Validation (RADV) methodology that the Department of Health and Human Services (HHS) runs on behalf of State based Marketplaces (SBMs) to the Medicare RADV methodology?
Answer: CMS does not have a common crosswalk that compares these two programs. Both programs adopt similar methods regarding the sampling concepts and methods that require implementation of national acceptable standards for review of enrollee health conditions to validate payment accuracy. However, HHS-operated RADV program differs in that our methods for assessing payment accuracy are driven primarily by principles that underlie our risk adjustment payment transfer methodology, which is not a payment concept for the MA program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 14, 2014
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