driney@phpcares.org
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Hello all.
I am a new AAPC member working on my CRC certification. I work for a start up health plan in NYC and we are working on conducting our first round of chart reviews for risk adjustment.
If a health plan has medical records and identifies discrepancies in their HCCs (assuming the medical records are from acceptable providers, appropriately attested, and all visits are face-to-face), do the retrospective chart review encounters need to be submitted on an actual claim form, or can the health plan submit these encounters and store the medical records as backup in preparation for a RADV audit?
Put another way - if I have a UB-04 claim form on the left side of my desk with 4 dx, and a medical record on the right side with 10 valid dx, what kind of back-up do I need to submit the missing diagnoses as an encounter, other than the medical record? Can I make an internal template of missing diagnoses and submit these as encounters? When the RADV audit comes along, the backup I would need to provide would be the medical record itself, correct?
Thank you for your help!
DDR
I am a new AAPC member working on my CRC certification. I work for a start up health plan in NYC and we are working on conducting our first round of chart reviews for risk adjustment.
If a health plan has medical records and identifies discrepancies in their HCCs (assuming the medical records are from acceptable providers, appropriately attested, and all visits are face-to-face), do the retrospective chart review encounters need to be submitted on an actual claim form, or can the health plan submit these encounters and store the medical records as backup in preparation for a RADV audit?
Put another way - if I have a UB-04 claim form on the left side of my desk with 4 dx, and a medical record on the right side with 10 valid dx, what kind of back-up do I need to submit the missing diagnoses as an encounter, other than the medical record? Can I make an internal template of missing diagnoses and submit these as encounters? When the RADV audit comes along, the backup I would need to provide would be the medical record itself, correct?
Thank you for your help!
DDR
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