Medicare Compliance & Reimbursement
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 adjust MA enrollees’ risk score — and determining MA organizations’ payments, OIG says. “Miscoded diagnoses may cause CMS to pay MA organizations improper amounts,” the agency warns. “For these audits, we will focus on enrollees who had diagnoses identified from unlinked chart reviews that resulted in increased risk-adjusted payments from CMS to MA organizations.” OIG intends the audit to run through 2026, suggesting a very comprehensive investigation of unlinked chart reviews, diagnosis codes used by MA organizations, and the role CMS’ risk adjustment plays in providers’ Medicare pay. Check out the Work Plan active item at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000799.asp.
Medicare Compliance & Reimbursement
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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 [...]
