RAAPID's Executive RADV Audit Webinar Now Available On-Demand for Medicare Advantage Plans

LOUISVILLE, Ky., June 26, 2025 /PRNewswire/ -- RAAPID, the M12 (Microsoft Venture) backed risk adjustment technology company, successfully concluded its executive webinar "Don't Wait for the Notice: How to Prepare for RADV Audits Now," featuring industry expert Wynda Clayton, MS, RHIT. The session is now available for on-demand viewing at the RAAPID Website.

During the 40-minute executive briefing, Clayton addressed CMS's historic shift from selective to universal RADV audits, which affect all eligible Medicare Advantage organizations. "RADV audits aren't just a compliance issue – they're a leadership priority that directly affects financial stability and organizational performance," Clayton emphasized during the presentation.

Significant Financial Implications Revealed

The webinar highlighted financial projections, with Clayton noting that "CMS has estimated that from 2023 through 2032, the agency will recover an additional 4.7 billion dollars from insurers due to RADV audit findings." She stressed the extrapolation methodology can amplify financial exposure, citing a case study where an initial $480,000 overpayment finding escalated to $27 million through extrapolation.

Clayton warned executives that recent OIG audits found that "69% of HCC payments were unsupported by documentation," resulting in overpayment findings. Estimates suggest that Medicare Advantage plans may be overbilling by $17-43 billion annually, driving an expansion of aggressive audits.

Leadership Accountability Across Departments

Clayton emphasized why CMOs, CFOs, and COOs must drive audit readiness culture across departments. She outlined specific executive responsibilities: CMOs must ensure clinical documentation integrity and physician education, CFOs need to establish audit-driven financial safeguards and reserves, while COOs should embed RADV readiness into standard operational workflows to prevent inefficiencies and enhance cross-departmental coordination.

Operational Changes and Urgency

The webinar addressed critical operational shifts, including compressed audit timelines. "For 2019, they have definitely cut the audit time by half – you only have, for the most part, 90 days to complete this audit," Clayton explained. "If you end up with 200 enrollees that you're going to have to audit, that's going to be a lot to get done in three months versus six months."

Clayton emphasized the importance of cross-departmental coordination, stating that executives must "secure buy-ins across departments for sustained compliance readiness" while ensuring "audit readiness is a leadership-driven initiative rather than just being a reactive compliance task."

Expert Leadership

Clayton brings over 20 years of risk adjustment experience and a unique perspective as both a former RADV auditor and a health plan executive who led organizations through successful audits. Chris Lally, RAAPID's VP of Operations with 30+ years of healthcare expertise, moderated the session.

MA Plans, ACOs, and VBC organizations can access the complete webinar presentation and resources at https://www.raapidinc.com/webinars/radv-audit/.

About RAAPID

Founded in 2022 by healthcare technology veterans with over 20 years of experience, RAAPID's HITRUST-certified platform transforms unstructured medical data into actionable insights. Following a Series A investment from M12, Microsoft's venture fund, RAAPID continues to expand its impact across Medicare Advantage, ACA, Medicare ACO, and Medicaid programs.

For more information, visit www.raapidinc.com.

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SOURCE RAAPID INC