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Surfacing High-Risk Diagnosis Codes: Leveraging OIG's Methodology to Ensure Integrity in Submissions


Learn the power of data analysis of medical and pharmacy claims for surfacing problematic diagnoses, and of NLP for evaluating these diagnoses.

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  • Discuss the recent literature from the Office of Inspector General focused on integrity in diagnosis code submissions, and impacts on coding in Medicare Advantage  

  • Learn the power of data analysis of medical and pharmacy claims for surfacing problematic diagnoses, and of NLP for evaluating these diagnoses

  • Understand how to efficiently follow-up on high-risk diagnosis codes in preparation for a potential future audit

  • Learn what data available in standard claims is key for customizing and expanding the search for high risk diagnosis codes

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