American Hospital Association March 6, 2023
The Centers for Medicare & Medicaid Services should require Medicare Advantage organizations to definitively indicate when they deny payment of a claim for service, the Department of Health and Human Services’ Office of Inspector General recommended Friday.
“We found that adjustment codes are not a definitive method for identifying denied claims in the MA encounter data,” OIG said. “The descriptions for some adjustment codes are too vague to clearly identify whether the MAO denied payment for a service. … We also found that most 2019 MA encounter records contained at least 1 adjustment code and 55 million of these records contained codes that may indicate the...
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