When the Chart Doesn’t Back the Code: Inside Three New OIG Risk Adjustment Audits
The Record Must Tell the Story Three out of every four sampled diagnoses didn’t hold up. That’s the headline from three new Office of Inspector General (OIG) audits of Medicare Advantage risk adjustment, and it should get the attention of every Clinical Documentation Improvement (CDI) specialist, coder, and compliance lead who touches a risk-adjusted claim. In Medicare Advantage, a diagnosis isn’t just a description of the patient. It’s a payment input. When a high-severity code…
