THE RADV CHECKLIST
Member Name: HCN:
Image ID: ________ DOS:________ Page #: ________
HCC: Diagnosis Code(s): ___________________________
- Is the correct member name on the Admission or Date of Service (ADM/DOS)?
- Is the ADM/DOS for the correct year?
- Does the documentation support a face-to-face visit?
- Is the ADM/DOS from a valid provider type and setting?
- Is the provider credentials/specialty documented on the ADM/DOS?
- Does the ADM/DOS contain an acceptable (legible) signature with date?
- If not, is a CMS-Generated Attestation needed for this DOS?
- Is the record for the correct calendar year for the payment year being audited?
- Is the date of service present for the face to face visit?
- Is the record legible?
- Is the record from a valid provider type?
- Are there valid credentials and/or is there a valid physician specialty documented on the record?
- If the outpatient/physician record doesn’t contain a valid credential and/or signature, is there a completed CMS-Generated Attestation for this date of service?
- Is there a current (legible) diagnosis that supports the HCC requested?
- If yes, does condition meet reporting criteria (MEAT)?
- If not, does the documentation support a higher weighted HCC?
- If not, does the documentation support a lower weighted HCC?
- Are any additional HCCs supported on this ADM/DOS?