Medicare Advantage Targeted By CMS For Overpayment
Health Affairs This Week
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CMS Pays Medicare Advantage Plans - Is That Correct?
CMS has long argued that MA plans have been overpaid. The audits focus on one in particular, known as coding intensity or upcoding. A patient's financial risk is based on the patient's health and amount of care they are likely to need. CMS then uses the diagnoses to develop a risk score for each patient,. Then the risk score is used to adjust the annual payments to MA plans.
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