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Physician Coding Errors Led to Millions in Overpayments For Stroke Patients, Says OIG

Posted by David Fong on Sep 29, 2020 10:00:00 AM

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A report from the U.S. Department of Health and Human Services' Office of Inspector General (OIG) earlier this month found improper physician coding of stroke patients who were transferred from traditional Medicare to Medicare Advantage, which led to overpayments of an estimated $14.4 million. The OIG found nearly all of the selected acute stroke diagnosis codes that physicians submitted to CMS under traditional Medicare that CMS later used to make payments to Medicare Advantage organizations didn't comply with federal requirements.


As reported in Becker's Hospital CFO Report, select diagnosis codes for acute stroke that map to the ischemic or unspecified stroke hierarchical condition categories are at high risk of being miscoded, according to the OIG. The OIG audit reviewed claims for 582 transferred enrollees who received a high-risk acute stroke diagnosis code in 2014 or 2015 to see if medical records support the submitted codes.

"These errors originated from physicians submitting incorrect acute stroke diagnosis codes on claims billed under traditional Medicare. However, these errors were unnoticed and caused inaccurate payments in MA because CMS did not have policies and procedures to identify beneficiaries who transferred from traditional Medicare to MA, and evaluate whether the acute stroke diagnosis codes submitted under traditional Medicare on their behalf complied with federal requirements," the OIG said.

The article noted that OIG called on CMS to improve its education for physicians and create policies that identify when patients are moving from traditional to Medicare Advantage plans. While CMS said the OIG's findings account for less than a half percent of all transferees, the agency agreed with the recommendations and plans to review and implement new policies.

Aviacode has experienced certified AAPC and AHIMA medical coders knowledgeable on the best practices of physician coding and facility coding. This knowledge helps ensure the proper coding is done at the appropriate levels and reimbursements. In addition, Aviacode offers experienced experts to help health systems on coding audits to ensure compliance to CMS and other federal guidelines.


Topics: Medical Coding, Medical Coding Audits, Pro-Fee Coding, Outpatient Coding, COVID-19