Becker's Healthcare November 20, 2025
Insurers carry out chart reviews to verify alignment between medical records and information submitted by providers. While these reviews can help payers understand a beneficiary’s needs and increase payments to accommodate anticipated costs, they could also be used inappropriately.
“Chart reviews can also identify diagnoses that are inaccurate, no longer an active consideration or unrelated to the clinical care enrollees receive, and thus potentially inappropriate to submit to CMS for payment purposes,” a Nov. 20 KFF report said.
A March study from the Annals of Internal Medicine estimated an extra $33 billion in payments to plans in 2021 due to coding differences.
Here are four takeaways from KFF’s analysis of 2022...
Today's Sponsors
Today's Sponsor