Lack Of Persistent Coding In Traditional Medicare May Widen The Risk-Score Gap With Medicare Advantage.

ABSTRACT: Payments to Medicare Advantage (MA) plans are adjusted by a risk-score model that is calibrated on diagnostic and demographic data from traditional Medicare beneficiaries and then applied to MA beneficiaries. If MA plans capture more diagnostic codes than traditional Medicare, they receive payment that is higher than the amount that would be spent in traditional Medicare. Although most previous research has focused on the coding practices of MA plans, less attention has been paid to the completeness of coding in traditional Medicare. We analyzed 2017-19 traditional Medicare claims data and MA encounter data to compare the persistence of diagnostic coding for sixteen chronic conditions. Our primary analysis found that the lack of persistent coding of these conditions in traditional Medicare

SUBMITTER: Ghoshal-Datta N 

PROVIDER: S-EPMC12091224 | biostudies-literature | 2024 Dec

REPOSITORIES: biostudies-literature