Differential coding by Medicare Advantage plans appeared to have pushed their risk scores higher than traditional Medicare's scores. Those greater risk scores led to $33 billion in extra revenue for ...

Differential coding in MA plans results in higher risk scores and increased payments compared to TM, with significant insurer variation. UnitedHealth Group's risk scores were significantly higher than ...

Some research suggests that risk adjustment plays a substantial role in explaining the high levels of government spending on Medicare Advantage (MA). We studied whether the reliance on diagnosis codes ...

Tara Bannow covers hospitals, providers, and insurers. You can reach Tara on Signal at tarabannow.70. Health insurers in the private Medicare business have a big incentive to diagnose their members ...

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 ...

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of ...

Medicare Advantage remains an attractive option for Medicare beneficiaries, and enrollment has increased substantially, by 66 percent in the past six years. Also increasing, it seems, is coding ...

Intensive coding by Medicare Advantage (MA) plans raised enrollees' risk scores and may have allowed companies to pocket tens of billions of dollars more than if traditional Medicare had covered the ...