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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: These estimates include CMS's 5.9% coding intensity adjustments.

The table depicts how various policy levers impact payments to parent organizations: 

  • Eliminating Chart Reviews: How much total payments to plans would change if all codes captured solely in chart reviews were removed.

  • Eliminating Health Risk Assessments: How much total payments to plans would change if all codes captured solely in HRAs were removed.

  • Variable Coding Adjuster: This calculation applies a variable adjuster to plan payments that reduces payments gradually depending on the plan’s overall payment intensity. More details on the calculation methods are in the Documentation page.

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