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Coding Intensity Differences by Contract

Potential Policy Solutions

Here we estimate the financial impact of several alternative strategies that can be used to address differential coding intensity in Medicare Advantage for the top ten largest parent companies.

Note: The grand total row in the table above only shows the totals for the ten largest parent companies.

The table depicts how various policy levers (see below) impact payments to parent organizations. 

  • Eliminating Chart Reviews: This calculation shows how much total payments to plans would change if all codes captured in chart reviews and no other sources are removed.

  • Eliminating HRAs: This calculation shows how much total payments to plans would change if all codes captured in HRAs and no other sources are removed

  • 5.9% Flat Adjustment: This is the current statutory minimum flat coding adjustment that CMS applies to all plans universally.

  • Variable Coding Adjuster: This calculation applies a variable adjuster to plan payments that reduces payments gradually depending on the plans overall payment adjustment. More details on the calculation are in the documentation page.

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