What should plans do when discovering submission of incorrect diagnosis codes?

The appropriate action for plans upon discovering the submission of incorrect diagnosis codes is to inform CMS immediately for potential recalculation. This approach aligns with the principles of transparency and accountability in the RADV audit process. By promptly notifying CMS, plans can initiate the process for correcting the data discrepancies, which can be essential for financial and program integrity. Additionally, timely communication allows for the potential recalculation of risk scores, ensuring that beneficiaries are accurately reflected in their risk adjustments, thus promoting fair and equitable healthcare funding.

Failing to report these inaccuracies could lead to larger issues in the future, including possible penalties or reputational damage for non-compliance with federal regulations. This course of action ultimately supports the overall goal of maintaining data integrity and provides an opportunity for the plan to rectify any reporting errors before they lead to financial implications.