Medicare Advantage plans are about to face unprecedented scrutiny as the Centers for Medicare & Medicaid Services (CMS) implements a dramatically expanded approach to RADV audits. Starting in 2025, every Medicare Advantage plan will be subject to contract-level RADV audits—a significant departure from the historical approach of randomly selecting 60 plans annually.
During this 17-minute podcast, Deborah Curry, risk adjustment programs director at Medical Mutual. breaks down the critical changes that compliance teams need to prepare for immediately. She offers practical strategies for surviving this new audit environment, emphasizing the importance of designated backup personnel, weekly progress huddles, and careful oversight of vendors retrieving medical records.
Whether you're already facing a RADV audit or preparing for the inevitable, this episode provides essential guidance for navigating CMS' aggressive new approach. For deeper insights, join RISE in Tampa, Fla. on October 21-23 for the 26th Risk Adjustment Forum, where Curry will be sharing additional strategies for RADV readiness.
About Deborah Curry
Deborah Curry, risk adjustment programs director, Medical Mutual, joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments. Prior to her position with Paramount, she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organization.
She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.
Curry attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Master of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA) and Certified Coding Specialist, physician based (CCS-P).Curry is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). She holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA and serves as a Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.
About the Risk Adjustment Forum
RISE’s Risk Adjustment Forum is designed for leaders in risk adjustment, coding, compliance, finance, and analytics across Medicare Advantage, Medicaid, Affordable Care Act, and commercial plans. The three-day event, which will take place Oct. 21-23 at the Grand Hyatt Tampa Bay, will tackle RADV audit ramp‑up and extrapolation, the Big Beautiful Bill Act, V28/RxHCC shifts, internal audit design, and CDI.