We recommend that BCBSM examine its existing compliance procedures to identify areas where improvements can be made to ensure diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS’s risk adjustment program) and take the necessary steps to enhance those procedures.
Questioned Costs
$0
Funds for Better Use
$0
Recommendation Status
Open
Source UUID
21-A-02-064-270165
Recommendation Number
270165
Significant Recommendation
No