tci Medicare Compliance & Reimbursement - 2023 Issue Q4

Industry Notes: OIG Doubles Down on Dx Miscoding Mishaps in Part C

Expect greater scrutiny as feds look at chart review results. Evidenced by numerous reports, Work Plan additions, and enforcement activity, Medicare Advantage (MA) organizations have been on the HHS Office of Inspector General’s (OIG’s) radar for some time. And now the national watchdog has added another Part C concern to its watchlist. Details: In Work Plan item WA-23-0037 (W-00-23-35903), OIG plans to home in on MA organizations’ unlinked chart reviews, looking specifically at risk adjustment issues in relation to diagnosis codes. The problem stems from the Centers for Medicare & Medicaid Services (CMS) using this information to...

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