OIG Toolkit To Help Decrease Improper Payments in Medicare Advantage Through the Identification of High-Risk Diagnosis Codes

OIG shared this 48 page Toolkit To Help Decrease Improper Payments in Medicare Advantage Through the Identification of High-Risk Diagnosis Codes released December 2023.

What Is the Toolkit?

"This toolkit is meant to be a practical, hands-on device that will help MA organizations improve the accuracy of their submitted diagnoses that are at high risk for being miscoded."

It includes a list of high-risk diagnosis codes that are consistently submitted to CMS.

This specifically helps the MA plans to adapt actual programming codes to query its internal data systems to accurately identity the enrollees in these high-risk groups. There is programming language included as well.

https://oig.hhs.gov/oas/reports/region7/72301213.pdf

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