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Tag Archives: HCC
Lessons from the Cigna/DOJ Lawsuit: Health Risk Appraisals (Part 2)
Last week’s first installment of this blog started our review of HRAs in the MRA environment. Let’s continue searching for lessons to apply in your practice. A third issue with Cigna’s HRAs was the supposed expectation to capture all the … Read Full Post
Compliance Tool-kit Should Include External Validation
Although all providers should have a Compliance Program, it seems that mostly larger groups have them in place and even then, to varying degrees. Many practices have some form of internal validation of a coder’s work; most of the time, … Read Full Post
Tagged auditing, coding compliance, compliance, HCC, medicare risk adjustment, mra, validation
Lessons from the Cigna/DOJ Lawsuit: Health Risk Appraisals (Part 1)
This blog is the first in a series of lessons, or reminders, gleaned from the Department of Justice’s (DOJ) lawsuit against health insurer Cigna. The suit alleges that Cigna essentially committed fraud by reporting false information to CMS in a … Read Full Post
The DOJ Targets MA Plans
The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) reported that a study conducted in 2019 revealed, “Unsupported risk adjusted payments are a major driver of improper payments in the Medicare Advantage (MA) … Read Full Post
Tagged Anthem, Cigna, DOJ, fraud, HCC, medical coding, medicare advantage plans, mra, risk adjusted reimbursement