RADV Compliance

Bedrock Health Group provides end-to-end support for Risk Adjustment Data Validation (RADV), helping Medicare Advantage organizations and providers safeguard revenue, meet CMS requirements, and stay audit-ready year-round. Our approach combines regulatory expertise, operational playbooks, and technology-enabled scoring to reduce exposure and strengthen compliance.

Why RADV Matters

RADV audits directly impact plan payments and compliance risk. Inaccurate or unsupported risk scores can lead to major financial clawbacks, reputational damage, and additional scrutiny from CMS. Providers and payers alike need a partner who can deliver evidence-backed accuracy and audit-defensible processes.

Our Approach

We go beyond one-off chart reviews. Bedrock builds a compliance delivery infrastructure that integrates RADV readiness into your daily operations.

Core components include:

• Risk Adjustment Data Integrity — Validate coding accuracy, clinical documentation, and encounter submissions.

• Chart Review & Coding Audit — Retrospective and prospective reviews with clinical and coding experts.

• Evidence Pack Creation — Organized audit-defensible documentation to present directly to CMS or delegated entities.

• Gap Identification & Closure — Pinpoint coding and documentation gaps, assign remediation tasks, and track completion.

• Claims & Encounter Flow Oversight — Verify timeliness, completeness, and CMS submission formatting.

• Training & Certification — Educate providers, coders, and compliance staff on risk adjustment standards and audit expectations.

• Ongoing Monitoring — Quarterly updates through the Bedrock Compliance Index, tracking RADV sub-scores and audit readiness trends.

The Handshake Process

RADV success depends on a clean, repeatable workflow between plans, providers, coders, and CMS. Bedrock manages that handshake:

1. Record Retrieval
   Secure collection of patient charts, claims, and encounter data from providers and EMRs.

2. Chart Review & Validation
   Clinicians and coders validate diagnoses against documentation and risk adjustment models.

3. Evidence Pack Assembly
   Create structured files with all supporting documentation, fully mapped to CMS requirements.

4. Submission Handshake
   Package evidence and findings into CMS-aligned templates; coordinate directly with plans or delegated vendors to ensure delivery.

5. Audit Response
   Support client teams during CMS audits with documentation, clarifications, and corrective action responses.

6. Remediation & Training
   Feed lessons learned into policy updates, coding practices, and staff training to reduce future exposure.

Why Choose Bedrock for RADV

• Integrated Expertise — We unite compliance officers, coders, data analysts, and audit managers under one process.

• CCR Mapping Engine — Our proprietary compliance mapping links RADV requirements to HIPAA, HITECH, and CMS rules for cross-framework readiness.

• Audit-Ready Evidence — Our evidence packs aren’t spreadsheets — they’re structured, regulator-ready files built to withstand scrutiny.

• Technology-Enabled Scoring — The Bedrock Compliance Index provides an ongoing RADV readiness score, not just a “pass/fail.”

• Scalable Delivery — Whether you’re a small provider group or a national MA plan, we scale teams for thousands of charts or targeted audits.

• Outsourced Leadership — Bedrock can serve as your interim Privacy Officer or Compliance Officer, bridging gaps in-house.

How It Works

1. Baseline Review — Quick scan of coding practices, encounter data, and audit history.

2. Workplan Setup — Define review scope (sample vs. population), assign roles, and set milestones.

3. Chart Review Cycle — Concurrent coding reviews with feedback loops for providers.

4. Evidence Pack Delivery — Assembled binder with medical record excerpts, coding rationale, and CMS-ready summaries.

5. Quarterly Compliance Briefing — Updates to leadership on RADV trends, risks, and Index score changes.

Who We Support

• Medicare Advantage Plans — End-to-end RADV audit management, encounter oversight, and clawback risk mitigation.

• Provider Groups — Chart documentation improvement, coding accuracy, and training to align with payer audits.

• Delegated Entities / Vendors — Independent validation, oversight, and remediation for vendor-managed risk adjustment programs.

Get RADV-Ready with Bedrock

With CMS ramping up RADV enforcement and clawbacks, now is the time to harden your program. Bedrock provides the people, process, and proof to keep your revenue intact and your compliance strong.