MA plans are projected to receive at least $30 Billion
in additional payments due to differential
coding intensity in 2025
Enrollees in Medicare Advantage have much higher rates of coding than their peers in Traditional Medicare. The MEDICODE Report Card aims to provide the public with information on which plans are receiving the most additional payment from risk score differentials.
Additional Payments Due to Risk Code Differential to the Ten Largest Medicare Advantage Parent Companies
These estimates are from an analysis of 2021 Medicare Advantage Encounter data projected forward to 2025 dollars. Estimates were calculated using a modified version of the DECI method. Each bubble represents a company. The bubble size represents how many enrollees are in that company. The x-axis is spending difference per member associated with differential coding intensity. The Y-axis is the aggregate spending difference across the entire company due to differential coding intensity. Our estimates may be smaller than estimates from other groups as we account for the V28 HCC model. These estimates do not reflect CMS's 5.9% coding intensity adjustment
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What Explains Differential Coding Intensity
Chart Reviews
MA Plans have the ability to update diagnoses included in beneficiary records through Chart Review encounters. We calculate below the percentage increase in risk scores due to codes added in Chart Reviews alone
Plans can conduct at home Health Risk Assessments which capture additional codes without necessarily leading to additional care. We calculate below the percentage increase in risk scores resulting from HRA captured diagnoses that don’t appear elsewhere in the patient’s records
Health Risk Assessments
Throughout this website we use a modified version of the Demographic Estimate of Coding Intensity (DECI) approach used by MedPAC and others to compare measured risk to expected risk among demographically similar beneficiaries. More details on how we calculated these scores can be found on the Documentation page
DECI Estimates
What proportion of differential coding intensity is explained by chart reviews and health risk assessments?
The chart depicts the percentage point impact of differential coding intensity amongst the top ten enrolled in Medicare Advantage companies. Note: chart review and health risk assessment differentials are not additive as some HRAs have their own chart reviews.
About
The goal of this research project is to shed light on differential coding practice across Medicare Advantage insurers and to make this information transparent and publicly available. This work was conducted by researchers at the Center for Advancing Health Policy Through Research at the Brown University School of Public Health (CAHPR). Our estimates are based on methods previously published in peer-reviewed literature. By including estimates, we make no representation concerning the truthfulness or accuracy of any coding - we only report on observed differences in coding. Our estimates may be lower than reported by MedPac because we use 2021 data in a blended HCC model.
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This calculations and data are open-source and can be found below.