Kirk L. Shanks, MAS, CRC has worked in Medicare Advantage risk adjustment for roughly twenty years, across payer, advisory and practitioner roles, with an actuarial background.
Payment models, submissions and audits, with every claim cited to the section it came from.
Kirk L. Shanks, MAS, CRC has worked in Medicare Advantage risk adjustment for roughly twenty years, across payer, advisory and practitioner roles, with an actuarial background.
A risk score is only as good as the data behind it. I trace yours from the encounter through to CMS, then show you where it breaks. You get the file and the figure, not a summary.
The CMS files, the claims, the chart review results. Most plans hold all three in places that don't agree with each other. I put them in one database you can query, and reconcile them against what CMS says it received.
Bring me the question before the deadline, not after. A submission, an audit, a bid assumption you want tested, a vendor result nobody can reproduce. You get a straight answer, and the section it came from.
The Centers for Medicare & Medicaid Services (CMS) opened the payment year 2024 Risk Adjustment Data Validation (RADV) audits on August 28 at 590 contracts. CMS scheduled the Enrollee Data List for September 11. Records are due February 5.
Sources: CMS, RADV Audit Schedule, Updated 08/28/2026. CMS, Payment Year 2024 Medicare Advantage Contract-Specific RADV Audit Methods and Instructions, 08/28/2026, section 3. CMS, Payment Year 2024 List of Audited Contracts, Published 08/28/2026. The 590 is my count of its rows.
The list tells you who was sampled. It doesn't tell you which records to send or what the frame is worth.
Plenty has been written about risk adjustment. Most of it tells you what to think and not where the number came from. That's the gap this practice fills. When something here is wrong, tell me and I will correct it in public.