IVA RADV Readiness

(return to MetaStar Readiness Series)

Comprehensive Pre-Audit Support for Affordable Care Act Risk Adjustment Data Validation

The Department of Health and Human Services (HHS)–Independent Validation Audit (IVA) is a cornerstone of the risk adjustment data validation (RADV) oversight under the Affordable Care Act (ACA). Plans selected for IVA must ensure their diagnosis data, medical records, and coding practices meet the Centers for Medicare & Medicaid Services’ (CMS) stringent audit standards.

MetaStar’s IVA RADV Readiness service offers end-to-end preparation support, drawing on our deep experience as an approved IVA Entity. We replicate key elements of the CMS audit protocol to identify data quality issues, documentation gaps, and coding vulnerabilities before formal submission.

Service Components Include

• Simulated IVA Workflow: Conduct mock audits using CMS-specified sampling, coding logic, and audit tools.
• Clinical Validation Reviews: Evaluate medical records against HHS- Hierarchical Condition Categories (HCC) criteria to assess support for submitted conditions.
• EDGE-to-Source Validation Checks: Ensure reported diagnoses align with documentation and EDGE server submissions.
• Error Rate and Impact Projections: Identify coding discrepancies likely to affect RADV error rates or extrapolation.
• Audit Tool Orientation: Walk through key IVA tool functions to improve internal stakeholder preparedness.
• Customized Readiness Report: Includes findings, risk categories, root causes, and prioritized action items.

Ideal For

• ACA-compliant health plans preparing for CMS-mandated IVA RADV audits.
• IVA Entities seeking to test internal processes or train staff ahead of live audits.
• Plans implementing a self-audit program to improve audit performance or vendor oversight

Why MetaStar?

With over a decade of risk adjustment audit experience, MetaStar brings unmatched expertise in navigating CMS audit protocols. Our readiness services are rigorous, independent, and aligned to your compliance goals.

Let’s Talk

Position your team for success before the audit begins.
Contact us to schedule a consultation or learn more about how MetaStar’s IVA RADV Readiness offering can support your organization.