Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices: Gao-12-51

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(as of Sep 15, 2023 21:34:09 UTC – Details)

GAO found that diagnostic coding differences exist between MA plans and Medicare FFS. Using data on beneficiary characteristics and regression analysis, GAO estimated that before CMS’s adjustment, 2010 MA beneficiary risk scores were at least 4.8 percent, and perhaps as much as 7.1 percent, higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. The higher risk scores were equivalent to $3.9 billion to $5.8 billion in payments to MA plans. Both GAO and CMS found that the impact of coding differences increased over time. This trend suggests that the cumulative impact of coding differences in 2011 and 2012 could be larger than in 2010.

Publisher ‏ : ‎ Bibliogov (16 May 2013)
Language ‏ : ‎ English
Paperback ‏ : ‎ 36 pages
ISBN-10 ‏ : ‎ 1287207146
ISBN-13 ‏ : ‎ 978-1287207146
Item Weight ‏ : ‎ 82 g
Dimensions ‏ : ‎ 18.9 x 0.19 x 24.6 cm
Country of Origin ‏ : ‎ India