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 testEHR amendment and audit-trail considerationsWhy provider sign-off isn't the whole analysisRisks of add-only retrospective reviewsHCC model/date-of-service considerationsAudit extrapolation conceptsFive project-design questionsWhat 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