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OIG Finds $462 Million in Potential Medicare Advantage Overpayments: What Acute Stroke Coding Reveals About Risk Adjustment Vulnerabilities
With ongoing scrutiny surrounding Medicare Advantage (MA) Risk Adjustment (RA), the Office of Inspector General (OIG) has issued another significant finding in its May audit report titled:…
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The Compliance Work Nobody Notices—Until a Preventable Mistake Becomes a Costly Problem
Let’s be honest: nobody gets excited about checklists. No one starts their day looking forward to reviewing controls, validating documentation, or double-checking a process they’ve completed hundreds…
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The POA Blind Spot: How Missing Present on Admission Indicators Can Distort Mortality Reporting
Present on Admission (POA) indicators do far more than support accurate coding and reimbursement. They play a critical role in reflecting patient severity of illness, risk of…
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Respiratory Distress Syndrome and Respiratory Failure Coding: A Common Mistake That Can Trigger Denials
Should respiratory distress syndrome (RDS) and respiratory failure be coded together? Since coding guidelines changed the relationship between these diagnoses from an Excludes 1 note to an…
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Your Best Employees May Already Have One Foot Out the Door
Most employees do not leave a company because of one bad day. They leave after months, sometimes years, of feeling invisible. A missed work anniversary. A birthday…
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The CDI Gaps Driving Your Denials and Compliance Exposure
Healthcare organizations are under sustained pressure from multiple directions: In this environment, organizations that treat Clinical Documentation Integrity (CDI) education as a strategic, data-driven investment are beginning…
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Medicare Advantage FCA Scrutiny Is Escalating … Could You Be Next?
Medicare Advantage is also known as the Medicare Part C program. This Medicare program combines traditional Medicare Part A and B into a Part C plan where…
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Is “In the Setting Of” Putting Your Claims at Risk?
Provider documentation often includes phrases that sound clinically meaningful but do not give coders enough support to assign a causal relationship. One common example is “in the setting…
