Retrospective Coding Gone Wrong Documentation, HCCs & False Claims Act

Retrospective Coding Gone Wrong Documentation, HCCs & False Claims Act

A diagnosis can be accurate—and still fail to support a claim if the documentation underneath it doesn't meet applicable requirements.

In this episode, Alicia Scott examines retrospective HCC coding through the lens of a major settlement involving allegations about medical-record amendments and risk adjustment data.

The discussion focuses on documentation provenance, amendment requirements, provider involvement, add-only reviews, audit trails, HCC models, and workflow design.

You'll learn:

  • The Identify–Attribute–Preserve test
  • EHR amendment and audit-trail considerations
  • Why provider sign-off isn't the whole analysis
  • Risks of add-only retrospective reviews
  • HCC model/date-of-service considerations
  • Audit extrapolation concepts
  • Five project-design questions
  • What to do when you identify a concern

This episode is from the CCO Podcast #1751 webinar.

Watch the full video here: https://youtu.be/OQPXZ6miyw0

Det här avsnittet är hämtat från ett öppet RSS-flöde och publiceras inte av Podme. Det kan innehålla reklam.

Avsnitt(63)

Breaking Into Revenue Cycle: Essentials for Medical Coders & Billers

Breaking Into Revenue Cycle: Essentials for Medical Coders & Billers

Trying to break into healthcare revenue cycle but don't know where to start? In this episode, Alicia Scott explains the five stages of revenue cycle, professional vs. institutional claims, common tra...

5 Okt 31min

You're Probably Missing These Z Codes

You're Probably Missing These Z Codes

Z codes are everywhere—but knowing when to report them and where to sequence them can be surprisingly challenging. You'll learn: First-listed vs. secondary Z codesStatus vs. historyScreening vs. dia...

1 Okt 40min

Wound Care Billing Changed BIG in 2026

Wound Care Billing Changed BIG in 2026

Wound and ulcer care coding changed significantly in 2026. You'll learn: 2026 skin substitute payment changesDeleted and replacement application codesApplied vs. discarded product unitsMAC LCD consi...

29 Sep 38min

Same-Day Professinal Billing - Outpatient to Inpatient Transitions

Same-Day Professinal Billing - Outpatient to Inpatient Transitions

A patient is seen in the clinic in the morning and admitted to the hospital that afternoon. Same physician, same date, two encounters. Do you bill both? In this episode, learn how same-day outpatien...

19 Sep 29min

What's New in FQHC Billing - Your 2026 Update

What's New in FQHC Billing - Your 2026 Update

FQHC billing changed significantly in 2026. In this episode, learn about the updated PPS base rate, retired G-codes, new APCM framework, behavioral health add-ons, RPM opportunities, and important te...

16 Sep 26min

Master the ICD-10-CM Alphabetic Index: Coding Conventions Made Easy

Master the ICD-10-CM Alphabetic Index: Coding Conventions Made Easy

Finding a diagnosis in ICD-10-CM is only the beginning. In this episode, learn how to navigate the ICD-10-CM Alphabetic Index correctly, understand key conventions like “With,” “See,” “See Also,” b...

12 Sep 40min

How to Code Critical Care: 99291, 99292, FS, FT & Time Rules

How to Code Critical Care: 99291, 99292, FS, FT & Time Rules

Critical care coding isn't about where the patient is—it's about condition, provider work, and time. In this episode, learn how to apply 99291 and +99292, meet the 30-minute requirement, count critic...

9 Sep 25min

Populärt inom Business & ekonomi

framgangspodden
rss-jossan-nina
varvet
rss-borsens-finest
badfluence
uppgang-och-fall
24fragor
avanzapodden
rss-dr-bjorklund
rss-inga-dumma-fragor-om-pengar
rss-kort-lang-analyspodden-fran-di
fill-or-kill
bathina-en-podcast
rss-dagen-med-di
tabberaset
kapitalet-en-podd-om-ekonomi
borsmorgon
lastbilspodden
rikatillsammans-om-privatekonomi-rikedom-i-livet
bilar-med-sladd