Medicare Advantage: CMS should improve the accuracy of risk score adjustments for diagnostic coding practices: report to congressional requesters. (Paperback) (ISBN-13: 9781974265312)

" The Centers for Medicare & Medicaid Services (CMS) pays plans in Medicare Advantage (MA)-the private plan alternative to Medicare fee-for-service (FFS)-a predetermined amount per beneficiary adjusted for health status. To make this adjustment, CMS calculates a risk score, a relative measure of expected health care costs, for each beneficiary. Risk scores should be the same among all beneficiaries with the same health conditions and demographic characteristics. Policymakers raised concerns that differences in diagnostic coding between MA plans and Medicare FFS could lead to inappropriately high MA risk scores and payments to MA plans. CMS began adjusting for coding differences in 2010. GAO (1) estimated the impact of any coding differences on MA risk scores and payments to plans in 2010 and (2) evaluated CMS's methodology for estimating the impact of these differences in 2010, 2011, and 2012. To do this, GAO compared risk score growth for MA beneficiaries with an estimate of what risk score growth would have been for those beneficiaries if they were in Medicare FFS, and evaluated CMS's methodology by assessing the data, study populations, study design, and beneficiary characteristics analyzed. "

Author: U. S. Government Accountability Office
ISBN-10: 1974265315
ISBN-13: 9781974265312
Publisher: Createspace Independent Publishing Platform
Language: English
Published: 08/05/2017
Pages: 34
Format: Paperback
Weight: 0.23lbs
Size: 11.02h x 8.50w x 0.07d