Lexology January 27, 2022
Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. In the past few years, the Office of the Inspector General (OIG) and the Department of Justice (DOJ) have focused on risk adjustment coding as an area susceptible to fraud which will likely continue into 2022. See below for an overview of risk adjustment coding, recent enforcement examples, and five tips for providers to help ensure accurate coding.
Risk Adjustment
Under the Medicare Advantage program, the Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage organizations (MAOs) a fixed per enrollee per month (PEPM) amount. For each enrollee, CMS adjusts the PEPM using diagnoses and demographics to determine...
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