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Healthcare Agencies II01:17

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There are various healthcare agencies in the United States—some of which are managed by religious institutions and others by different government branches.
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Identifying Coding Intensity in Medicare Advantage Through Switchers.

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Summary
This summary is machine-generated.

Medicare Advantage plans show higher health risk coding intensity compared to traditional Medicare. This difference in coding intensity increased over time, suggesting potential overpayments for Medicare Advantage enrollees.

Keywords:
MedicareMedicare Advantageclinical codingmanaged competitionrisk adjustment

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Area of Science:

  • Health economics
  • Health services research
  • Medical coding analysis

Background:

  • Traditional Medicare (TM) and Medicare Advantage (MA) have different payment structures.
  • Previous research indicates higher diagnosis counts and severity in MA compared to TM.
  • Understanding coding intensity differences is crucial for accurate Medicare payments.

Purpose of the Study:

  • To quantify the difference in health risk coding intensity between TM and MA.
  • To analyze how coding intensity evolves over time for beneficiaries switching to MA.
  • To provide evidence for adjusting MA payments based on coding intensity.

Main Methods:

  • Comparison of risk scores for beneficiaries switching from TM to MA versus those remaining in TM.
  • Utilized a 10% sample of Centers for Medicare and Medicaid Services data (2012-2021).
  • Linked administrative data with Medicare Current Beneficiary Survey for health status measures.

Main Results:

  • Risk scores for MA switchers were 12.4% higher by year two, 17.2% by year three, and 22.3% by year six.
  • Overall, MA coding intensity resulted in 18.6% higher risk scores compared to TM in 2021.
  • Coding intensity increased over time and across different enrollment cohorts.

Conclusions:

  • The study's coding intensity estimates are at the higher end of existing literature.
  • Findings address concerns regarding endogenous switching in MA enrollment.
  • Results can inform policy adjustments for MA payments to account for coding intensity differences.