CMS has initiated PY 2020 RADV audits and published a broader schedule for additional payment years, making RADV a live operational issue for Medicare Advantage plans. Pareto Intelligence helps plans move from audit pressure to a practical course of action with chart strategy, retrieval planning, coding support, financial impact analysis, and advisory guidance built for government programs.
CMS has started PY 2020 and PY 2021 audits and laid out a broader schedule for additional payment years, which means more plans need to be ready.
Teams need early clarity on ownership, timing, and key decisions. For many organizations, the hardest part is establishing that clarity soon enough to respond well.
Launched March 2026; records due August 28, 2026
Active
Notices issued May 2026; records window open
Active
Initiation scheduled Aug 2026
Scheduled
Initiation scheduled Nov 2026
Scheduled
Initiation scheduled Jan 2027
Scheduled
Initiation scheduled Apr 2027
Scheduled
Sources: CMS RADV Audit Schedule (Mar 4, 2026); PY 2020 Audit Methods & Instructions (Mar 20, 2026). Dates subject to change.
Once an audit is active, the work expands quickly. Many organizations are also balancing retrospective work, prospective and concurrent initiatives, compliance demands, and planning for additional audit waves already on the CMS schedule. Once an audit is active, the work expands quickly. Many organizations are also balancing retrospective work, prospective and concurrent initiatives, compliance demands, and planning for additional audit waves already on the CMS schedule.
Sampled member and HCC review
Chart prioritization
Retrieval coordination
Coding review and support
Financial impact visibility
Multi-year readiness
Early review shapes which records to chase and where effort needs to go first.
Teams need to focus on the records most likely to support validated conditions.
Historical records can be difficult to locate, especially when providers have moved, retired, or changed systems.
Records still need to be evaluated carefully so submissions are accurate and defensible.
Plans need a practical view of where non-validation may create exposure.
The next audit waves are already on the CMS schedule, so plans cannot focus on one plan year alone.
Sampled member and HCC review
Early review shapes which records to chase and where effort needs to go first.
Chart prioritization
Teams need to focus on the records most likely to support validated conditions.
Retrieval coordination
Historical records can be difficult to locate, especially when providers have moved, retired, or changed systems.
Coding review and support
Records still need to be evaluated carefully so submissions are accurate and defensible.
Financial impact visibility
Plans need a practical view of where non-validation may create exposure.
Multi-year readiness
The next audit waves are already on the CMS schedule, so plans cannot focus on one plan year alone.
Pareto helps plans bring structure to the response process so teams can make decisions faster, assign effort more effectively, and keep the work moving. The emphasis is on practical execution and experienced guidance across the functions involved in RADV.
Pareto helps teams identify which members, conditions, and records need attention first so effort is directed where it matters most.
Pareto helps structure chart chase efforts, retrieval workflows, and outreach plans to improve record capture.
Pareto brings risk adjustment expertise to support compliant coding review and documentation evaluation.
Pareto helps plans understand where validation gaps may create exposure and where additional attention is warranted.
Pareto provides experienced guidance to help teams coordinate timelines, decisions, and response planning across stakeholders.
Vice President, Risk Adjustment Consulting
Eric helps plans translate risk adjustment expertise into disciplined execution, aligning consulting guidance with the day-to-day decisions required to keep RADV work moving.
Principal, Risk Adjustment Consulting
Kevin brings direct RADV and government program consulting experience to help plans assess audit demands, set priorities, and move through documentation and coding complexity with a more focused plan.
Director, Risk Adjustment Consulting
Kacey brings 20+ years of healthcare experience in HCC compliance, medical record auditing, coding education, and risk adjustment program operations. She focuses on providing guidance to health plans and value-based care entities across government programs including MA, PACE, ACA, and Medicaid.
Manager, Risk Adjustment Consulting
Darlene brings deep expertise in medical coding, HCC compliance, medical record auditing, and clinical documentation integrity. She works with health plans and value-based care entities to deliver strategic insights and improve risk adjustment accuracy across government programs.
Vice President, Risk Solutions
Rick connects analytics, operations, and response strategy so plans can move through audit pressure with more clarity and control.
If your plan is preparing for RADV, Pareto can help your team align on next steps and move forward with a clearer approach. The conversation starts with where you are now, what pressure points you are seeing, and where added support would be most useful.
Fill out the form and our RADV team will follow up to schedule a conversation.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
