E/M Coding Alert - 2023 Issue 19
Industry Notes: OIG Doubles Down on Dx Miscoding Mishaps in Part C
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Article Overview
This article explains a new HHS Office of Inspector General work plan item focused on Medicare Advantage Part C oversight. It describes how the audit is expected to examine unlinked chart reviews, diagnosis coding, and the way CMS uses risk adjustment in payment calculations. The piece is aimed at readers tracking compliance, audit risk, and Medicare Advantage payment integrity.
Why This Topic Matters
The topic matters because Medicare Advantage organizations and compliance teams need to understand where federal scrutiny is increasing and what areas of documentation and coding are being reviewed. It also signals potential audit exposure tied to diagnosis-related risk adjustment processes.
What You Will Learn
- The general Medicare Advantage oversight issue highlighted by the OIG
- Why chart review activity is being examined in the context of risk adjustment
- How CMS payment integrity concerns relate to diagnosis coding and audits
- Which federal organizations and work plan activity are driving attention to Part C compliance
Who Should Read This
- Medicare Advantage compliance teams
- Medical coders and coding auditors
- Revenue integrity professionals
- Healthcare reimbursement staff
- Risk adjustment and quality reporting teams
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