Thursday, September 1, 6:35pm - 7:20pm (EDT)
Presentation Topic: Surfacing High Risk Diagnosis Codes: Leveraging OIG’s Methodology to Better Ensure Integrity in Submissions
Since 2021, the Office of Inspector General has employed a new audit methodology to surface non-compliant diagnosis codes, by scrutinizing particular fact patterns in coding data that correlate with improper documentation. It refers to these fact patterns as “Selected High Risk Diagnosis Codes”. Since integrity in all diagnosis submissions is paramount for Medicare Advantage risk adjustment, health plans are well served by applying OIG’s methodology to their own data, in order to surface and correct these common coding errors, and ultimately better coordinate care. Facility with this type of analyses also empowers a health plan to anticipate other fact patterns in its submissions that may point to improper coding.
In this presentation we will:
InterContinental Hotel, Los Angeles, CA
Maia Lee, maia.lee@episource.com