New Studies on Medicare Advantage Coding Intensity Seek to Level the Playing Field
-
Feb 20, 2025
As the new administration digs around for ways to cut costs, two recent studies highlight the drivers of overpayment in Medicare Advantage and suggest potential reforms. In one, researchers suggest that excluding the top 10 diagnosis groups from the Medicare Advantage risk adjustment model would slash billions in overpayments and level the playing field between MA and original, fee-for-service (FFS) Medicare. And a separate analysis proposes applying different coding intensity reductions based on individual MA organizations’ level of upcoding.
MA plans report diagnosis codes more thoroughly than FFS, leading to higher risk scores and, consequently, higher payments — a practice known as coding intensity. Critics have held that coding intensity creates a significant discrepancy in payments between MA and FFS, and they say it raises concerns about the fairness and sustainability of the MA program. The Medicare Payment Advisory Commission (MedPAC) estimates that as a result of coding intensity, MA plans were overpaid by more than $50 billion in 2024 alone.
Read more
© 2024 MMIT
Related Posts
The Latest
Meet Our Reporters
Meet Our Reporters
GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND
Sign up for publications to get unmatched business intelligence delivered to your inbox.