Michelle2179
New
I am doing a RADV audit for patients for DOS in 2006. A high level definition of the RADV audit is Risk Adjustment data Validation, that requires us (Medicare Advantage Insurance Company) to validate a patients diagnosis that we submitted to CMS.
CMS has a list of the Chronic 7's, but there is conflicting information and I would like some guidance. The 2 most frequest diagnosis' targeted by CMS are COPD and CHF. I am finding these dx's in the PMH but not in the active medical problems or the assement and plan in the MD'd note. The patients are taking chronic medications for both COPD and CHF.
Should I code the 428.0 (CHF) and 496 (COPD) to validate the patients diagnosis, although the physician states they are both history of's?
CMS has a list of the Chronic 7's, but there is conflicting information and I would like some guidance. The 2 most frequest diagnosis' targeted by CMS are COPD and CHF. I am finding these dx's in the PMH but not in the active medical problems or the assement and plan in the MD'd note. The patients are taking chronic medications for both COPD and CHF.
Should I code the 428.0 (CHF) and 496 (COPD) to validate the patients diagnosis, although the physician states they are both history of's?