OIG Work Plan Update Aimed at Medicare Advantage Risk Adjustment Coding

Today, the OIG issued their July Work Plan.  The update is heavily focused on risk adjustment coding (Hierarchical Condition Category (HCC) Coding).  The OIG announced the following:

  1. They will be developing a toolkit for MA plans to use to audit provider reporting of HCC conditions,
  2. They will be auditing HCC conditions reported in conjunction with annual wellness visits. 
  3. They will be auditing HCC conditions reported on physician or outpatient claims that were not reported on concurrent hospital inpatient claims.    

Risk adjustment coding has been identified as a top compliance risk area for the last several years.  The OIG announced earlier this year risk adjustment coding was a top enforcement priority.  We recommend performing a comprehensive review of your clinical documentation and HCC coding.  There have been dozens of OIG audit reports which outline common diagnosis and documentation errors, particular attention should be given to these areas.

The Work Plan items can be found here:  https://oig.hhs.gov/reports-and-publications/workplan/updates.asp

We are here to help.  The HBE team is available to assist you with all of your coding, billing and compliance program needs.  We routinely provide compliance partner services to large health systems as well as physician practices. Our services include:

  • Risk Assessments
  • Coding accuracy review
  • Clinical documentation improvement reviews
  • Policy and procedure development
  • Customized education and training for clinical and administrative staff

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