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Diane Publishing Books
Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices
James C. Cosgrove (au)
The Centers for Medicare & Medicaid Services (CMS) pays plans in Medicare Advantage (MA) -- the private plan alternative to Medicare fee-for-service (FFS) -- a predetermined amount per beneficiary adjusted for health status. To make this adjustment, CMS calculates a risk score, a relative measure of expected health care costs, for each beneficiary. Risk scores should be the same among all beneficiaries with the same health conditions and demographic chaacteristics. Policymakers raised concerns that differences in diagnostic coding between MA plans and Medicare FFS could lead to inappropriately high MA risk scores and payments to MA plans. CMS began adjusting for coding differences in 2010. This report (1) estimated the impact of any coding differences on MA risk scores and payments to plans in 2010 and (2) evaluated CMSäó»s methodology for estimating the impact of these differences in 2010, 2011, and 2012. Includes recommendations. Tables and figures. This is a print on demand report.
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