Here’s what you should know.
1. The average risk score for Medicare Advantage beneficiaries continues to rise by approximately 1.5 percent per year. CMS uses these risk scores to determine its payments to Medicare Advantage plans.
2. Despite the increasing risk scores, there’s no evidence that beneficiaries have gotten any sicker. Researchers allege if this practice continues, Medicare will overpay the Medicare Advantage program by approximately $200 billion.
3. Richard Kronick, PhD, principal investigator, said, “Congress and CMS have the opportunity to establish a payment system that will protect taxpayers from the strategies used by MA plans to increase the payments they receive. The projected $200 billion in overpayments over the next 10 years is stunningly large in absolute dollar terms. To provide some perspective, federal support for community health centers is approximately $5 billion per year.”
4. Dr. Kronick said CMS could solve the problem by adjusting for coding intensity while assuming beneficiaries are no healthier or sicker than demographically similar Medicare beneficiaries.
More articles on coding, billing and collections:
Republican legislator makes moves to lower drug prices through endorsing bill: 4 things to know
Payers increasing scrutiny of coding compliance
Kaiser Family Foundation: 7 things to know about Medicare & its financial future
