tci Medicare Compliance & Reimbursement - 2023 Issue Q1

Industry Notes: Feds Continue to Scrutinize MA Plans

Medicare Advantage plans have been the subject of both policy updates and scrutiny over the last year — and two recent reports suggest that the feds aren’t letting up on that fixation any time soon. Report #1: Medicare doesn’t require MA plans to use a claim denial indicator on denied claims, and that makes it a challenge to track such denials. So concludes an HHS Office of Inspector General (OIG) report released on March 2. “Adjustment codes are not a definitive method for identifying denied claims in the MA encounter data. The descriptions for some adjustment...

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