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Physician practices examine risk adjustment coding in wake of federal lawsuits | Healthcare Finance News

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mktoMunchkinFunction('visitWebPage', { url: '/news/physician-practices-examine-risk-adjustment-coding-wake-federal-lawsuits', params: 'topic1=compliancelegal&topic2=coding&topic3=riskmanagement&primarytopic=coding' }); </script><meta name="description" content="Doctors need to carefully and properly use the HCC codes, which indicate the expected costs for a patient." /> <link rel="shortcut icon" href="https://www.healthcarefinancenews.com/sites/healthcarefinancenews.com/files/healthcarefinance_favicon.png" type="image/png" /> <script type="text/javascript">dataLayer = [{"userUid":"95376","language":"en","entity_type":"node","type":"news","id":"136139","title":"Physician practices examine risk adjustment coding in wake of federal lawsuits","status":"published","country":"US","sitename":"Healthcare Finance News","author":"Jeff Lagasse","created":"20170925","words count":365,"links count":8,"video embed":"N","resourceType":false,"comments":0,"sponsored":"N","featured":"N","taxonomy":{"content":"","event":"","language":"","region":"","topic":{"primary":"","secondary":""},"tag":""},"topic":"","tag":"","marketo_params":"type=news\u0026id=136139\u0026title=Physician+practices+examine+risk+adjustment+coding+in+wake+of+federal+lawsuits\u0026topic=\u0026tag="}];</script> <meta name="description" content="A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. 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</div> <div class="row"> <div class="stickyParent system-main"> <section class="col-sm-8 col-xs-12"> <a id="main-content"></a> <div class="region region-content"> <div id="block-system-main" class="block block-system block-system-main clearfix" > <div class="content"> <article id="node-136139" class="node node-news clearfix col-md-12 col-sm-12 col-xs-12" about="/news/physician-practices-examine-risk-adjustment-coding-wake-federal-lawsuits" typeof="sioc:Item foaf:Document" node="136139"> <header> <div class="created-topic"> <span class="submitted">Sep 25, 2017</span> <span class="topic">More on <a href="/resource-topic/icd-10-coding">ICD-10 & Coding</a></span> </div> <h1 class="node-title">Physician practices examine risk adjustment coding in wake of federal lawsuits</h1> <h2 class="sub-header"> Doctors need to carefully and properly use the HCC codes, which indicate the expected costs for a patient. </h2> <div class="author col-md-12 col-sm-12 col-xs-12"> <div class="author-item col-md-12 col-sm-12 col-xs-12"> <div class="editor col-sm-8 col-xs-12"> <div class="author-inline "> <div class="avatar" style="background: url(https://www.healthcarefinancenews.com/sites/healthcarefinancenews.com/files/styles/avatar/public/Screen%20Shot%202015-11-24%20at%2011.54.19%20AM.png?itok=4riS_ibZ) center 0;"> <a href="/news/author/90301"><img src="/sites/healthcarefinancenews.com/themes/hfn/images/circle-over.png"></a> </div> <span class="author-name"><a href="/news/author/90301">Jeff Lagasse</a></span><span class="job-title"><strong>,</strong> Editor</span> </div> </div> <div class="social-media col-sm-4 col-xs-12"> <script type="text/javascript"> var addthis_share = { // ... other options url_transforms : { shorten: { twitter: "bitly" } }, shorteners : { bitly : {} }, passthrough : { twitter: { via: "HC_Finance" } } } </script> <script type="text/javascript">var addthis_config = {"data_track_addressbar":false};</script> <!-- Go to www.addthis.com/dashboard to customize your tools --> <script type="text/javascript" src="//s7.addthis.com/js/300/addthis_widget.js#pubid=ra-536be1326a353683" async="async"></script> <!--<div class="addthis_custom_sharing"></div>--> <div class="addthis_sharing_toolbox" data-url="https://www.healthcarefinancenews.com/news/physician-practices-examine-risk-adjustment-coding-wake-federal-lawsuits"></div> </div> </div></div> </header> <div class="content" > <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><div class="companion_image companion_top"><img typeof="foaf:Image" src="https://www.healthcarefinancenews.com/sites/healthcarefinancenews.com/files/styles/companion_top/public/UnitedHealth.caption_2.jpg?itok=2vencDVO" width="635" height="353" alt="" /><div class="image-field-caption"></div></div><p>A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn't involve physician practices, many practices are now paying more attention to risk adjustment coding than ever.</p> <p>At the heart of the UnitedHealth lawsuit is the claim that the insurer inflated its Medicare Advantage risk scores, which are determined by the level of services required by each beneficiary. Higher risk scores translate into higher payments from the government, and the contention is that this dynamic has created an incentive for plans to squeeze the maximum <a class="directory-item-link" href="/directory/reimbursement" target="_blank">reimbursement</a> possible.</p> <p class="see-also"><strong>[Also:</strong> <em><a href="/news/canopy-health-add-unitedhealthcare-unique-provider-payer-network-california">Canopy Health to add UnitedHealthcare to unique provider-payer network in California</a></em><strong>]</strong></p> <p>The federal government claims MA plans overcharge the Centers for Medicare and Medicaid Services after sifting through physicians' medical records and greenlighting codes that generate higher payments.</p> <p>A report in Neurology Today advises physicians to be on their toes: The codes, it said, affect physician pay and insurance contracting opportunities. Physicians should monitor the outcome of the lawsuits as value-based payment frameworks continue to spread and gain traction.</p> <p class="see-also"><strong>[Also:</strong> <em><a href="/news/unitedhealthcare-gives-out-234000-grants-help-consumers-rural-areas-kansas-gain-access-care">UnitedHealthcare gives out $234,000 in grants to help consumers in rural areas of Kansas gain access to care</a></em><strong>]</strong></p> <p>High-cost patients in MA plans are identified if a provider selects Hierarchical Condition Categories codes from the larger <a class="directory-item-link" href="/directory/icd-10" target="_blank">ICD-10</a> set, and the importance of those codes only increases as the broader healthcare system transitions from <a class="directory-item-link" href="/directory/fee-service-ffs" target="_blank">fee-for-service</a> to value-based payment models. While physicians can use these codes to generate a high-risk score and receive more reimbursement for complicated patients, they need to carefully and properly use the HCC codes, which indicate the expected costs for a patient.</p> <p>According to Neurology Today, the lawsuits suggest the Department of Justice is zeroing in on risk adjustment practices. For its part, UnitedHealth has denied the allegations.</p> <p class="see-also"><strong>[Also:</strong> <em><a href="/news/unitedhealth-groups-stephen-hemsley-stepping-down-ceo">UnitedHealth Group's Stephen Hemsley is stepping down as CEO</a></em><strong>]</strong></p> <p>The <a class="directory-item-link" href="/directory/government-accountability-office" target="_blank">Government Accountability Office</a> estimates the federal government made about $16 billion in improper payments to MA health plans last year, with the inappropriate use of codes being the primary factor. MA plans now cover about one-third of all Medicare beneficiaries.</p> <p><em>Twitter: <a href="https://twitter.com/jeff_e_lagasse" target="_blank">@JELagasse</a><br /> Email the writer: <a href="mailto:jeff.lagasse@himssmedia.com">jeff.lagasse@himssmedia.com</a></em></p> </div></div></div> </div> <!-- <div id="show_all_comments"> <div class="header"> <span>Show All Comments</span> <img class="plus" src="/sites/healthcarefinancenews.com/themes/hfn/images/comment_plus.png" /> <img class="sub" src="/sites/healthcarefinancenews.com/themes/hfn/images/comment_sub.png" /> </div> <div class="comment-content" id="disqus-wrapper"></div> </div> --> <script type="text/javascript"> window.next_post_layout = 'default'; </script> <div class="related-content clear" class="col-md-12 col-sm-12 col-xs-12"> <div class="block webinars-block"> <div class="block-title">News</div> <div class="sliders"><div class="slide col-md-12 col-sm-12 col-xs-12" > <a target="" href="/news/healthcare-organizations-ask-hhs-delay-quality-measure-reporting-acos" title="Healthcare organizations ask HHS to delay quality measure reporting for ACOs"> <img class="thumbnail_300x134" typeof="foaf:Image" src="https://www.healthcarefinancenews.com/sites/healthcarefinancenews.com/files/styles/thumbnail_300x134/public/QualityReportingJoseLuisPelaez.jpg?itok=cAwVos3P" width="300" height="134" alt="Healthcare organizations ask HHS to delay quality measure reporting for ACOs" /> <span class="title">Healthcare organizations ask HHS to delay quality measure reporting for ACOs</span> </a> <span class="webinar-teaser">The American Hospital Association and American Medical Association are among the 11 organizations signing the letter.</span> </div><div class="slide col-md-12 col-sm-12 col-xs-12" style="display: none;"> <a target="" href="/news/ending-racism-healthcare-often-begins-medical-education-and-target-new-national-project" title="Ending racism in healthcare often begins with medical education - and is the target of a new national project"> <img class="thumbnail_300x134" typeof="foaf:Image" src="https://www.healthcarefinancenews.com/sites/healthcarefinancenews.com/files/styles/thumbnail_300x134/public/black_patient_doc_vaccine_FG%20Trade_Getty%20Images.jpg?itok=hUCNSPlz" width="300" height="134" alt="Ending racism in healthcare often begins with medical education - and is the target of a new national project" /> <span class="title">Ending racism in healthcare often begins with medical education - and is the target of a new national project</span> </a> <span class="webinar-teaser">Inequities can be found in every facet of the industry, but targeting medical students and residents can help stem the tide.</span> </div> </div> </div><div class="clear"></div></div> </article> <!-- /.node --> </div> </div> </div> </section> <aside class="col-xs-12 col-sm-4 col-md-4" role="complementary"> <div class="stickySpacer"> <div class="region region-sidebar-second"> <div id="block-multiblock-47" class="block block-multiblock block-enterprise-ads block-enterprise-ads-ads_box_right1-instance block-multiblock-47 clearfix" > <div class="block-title"><none></div> <div class="content"> <div id="ads_box_right1" class="enterprise-ads enterprise-ads-box" data-slot="box" data-pos="right1"></div> </div> </div><div id="block-multiblock-49" class="block block-multiblock block-enterprise-ads block-enterprise-ads-ads_box_mobile_mobi_box2-instance block-multiblock-49 clearfix" > <div class="block-title"><none></div> <div class="content"> <div id="ads_box_mobile_mobi_box2" class="enterprise-ads enterprise-ads-box-mobile" data-slot="box_mobile" data-pos="mobi-box2"></div> </div> </div><div id="block-multiblock-48" class="block block-multiblock block-enterprise-ads block-enterprise-ads-ads_box_right2-instance block-multiblock-48 clearfix" > <div class="block-title"><none></div> <div class="content"> <div id="ads_box_right2" class="enterprise-ads enterprise-ads-box" data-slot="box" data-pos="right2"></div> </div> </div><div id="block-multiblock-16" class="block block-multiblock block-block block-block-36-instance block-multiblock-16 clearfix" > <div class="content"> <div class="subscribe-block"> <h3>Breaking News. 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