OIG: Physician coding errors led to millions in overpayments for stroke patients

” These mistakes originated from doctors submitting inaccurate severe stroke diagnosis codes on claims billed under traditional Medicare. These mistakes were undetected and triggered incorrect payments in MA because CMS did not have policies and procedures to identify beneficiaries who transferred from standard Medicare to MA, and evaluate whether the intense stroke diagnosis codes submitted under traditional Medicare on their behalf complied with federal requirements,” the OIG stated..

Morgan Haefner –
Monday, September 21st, 2020

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OIG discovered nearly all of the selected acute stroke diagnosis codes that physicians sent to CMS under traditional Medicare that CMS later on utilized to pay to Medicare Advantage organizations didnt adhere to federal requirements. This resulted in overpayments of $14.4 million to the Medicare Advantage companies.

Select diagnosis codes for severe stroke that map to the ischemic or unspecified stroke hierarchical condition classifications are at high danger of being miscoded, according to the OIG. For its audit, OIG evaluated claims for 582 transferred enrollees who got a high-risk acute stroke diagnosis code in 2014 or 2015 to see if medical records support the sent codes.

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When clients are moving from traditional to Medicare Advantage plans, OIG called on CMS to improve its education for doctors and create policies that identify. While CMS said the OIGs findings account for less than a half percent of all transferees, the firm concurred with the recommendations and strategies to review and implement brand-new policies.

Physicians have not appropriately coded for stroke clients who transferred from traditional Medicare to Medicare Advantage, causing inflated payments to Medicare Advantage companies, according to a Sept. 16 report from HHS Office of Inspector General.

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