Medicare Advantage coding requires a lot of attention to detail, and submitting inaccurate diagnoses for reimbursement could be a compliance nightmare, according to an article from AAPC, a professional medical coding organization.
MA plans reimburse hospitals and physician practices based on hierarchical condition categories. Here are the "top 10" coding errors for MA risk adjustment, according to AAPC.
1. The record does not contain a legible signature with credential.
2. The electronic health record was not signed electronically.
3. The highest degree of specificity was not assigned the most precise ICD-9-CM code.
4. Discrepancies exist between the diagnosis codes that are billed and what's written in the medical record.
5. Clinical documentation does not say if the patient's diagnoses are being monitored, evaluated, assessed or treated.
6. The status of a patient's cancer is unclear.
7. Chronic conditions are not documented as chronic.
8. Documentation does not go into enough depth of disease, injury, illness, etc.
9. Chronic conditions are not placed in the medical record at least once annually.
10. Information is missing for a diabetic complication.
MA plans reimburse hospitals and physician practices based on hierarchical condition categories. Here are the "top 10" coding errors for MA risk adjustment, according to AAPC.
1. The record does not contain a legible signature with credential.
2. The electronic health record was not signed electronically.
3. The highest degree of specificity was not assigned the most precise ICD-9-CM code.
4. Discrepancies exist between the diagnosis codes that are billed and what's written in the medical record.
5. Clinical documentation does not say if the patient's diagnoses are being monitored, evaluated, assessed or treated.
6. The status of a patient's cancer is unclear.
7. Chronic conditions are not documented as chronic.
8. Documentation does not go into enough depth of disease, injury, illness, etc.
9. Chronic conditions are not placed in the medical record at least once annually.
10. Information is missing for a diabetic complication.
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