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In recent audits of Medicare Advantage plans, the OIG has included codes for lung, breast, prostate, and colon cancers. In the report, they state that many of the cancer codes were not supported because the patient "did not have surgical therapy, radiation treatments, or chemotherapy drug treatments administered within a 6-month period before or after the diagnosis".
My question is- Is anyone aware of any guidance on how the OIG looks at hormonal therapy for breast and prostate cancers? And can you point me to the guidance?
If you'd like to review the most recent audit, here's the link the recent Humana Choice audit https://oig.hhs.gov/oas/reports/region5/51900039.pdf
Thanks in advance!
My question is- Is anyone aware of any guidance on how the OIG looks at hormonal therapy for breast and prostate cancers? And can you point me to the guidance?
If you'd like to review the most recent audit, here's the link the recent Humana Choice audit https://oig.hhs.gov/oas/reports/region5/51900039.pdf
Thanks in advance!