CMMI taking hard look at Medicare Advantage coding practices and impact on payment models

Fierce Health Payers January 20, 2022
Robert King

The Center for Medicare and Medicaid Innovation (CMMI) wants to replace or improve its risk adjustment methodology after concerns of Medicare Advantage plans upcoding to get higher payments, the center’s director said.

CMMI Director Liz Fowler, Ph.D., detailed how the center plans to shift the focus in its payment models to care delivery during a webinar Wednesday sponsored by the advocacy group United States of Care. The remarks come as scrutiny over MA coding practices has loomed over the lucrative market.

“There has been a lot written about the ability to engage in coding and upcoding gains and it’s a way of maybe getting better payments or higher payments without actually delivering care,” Fowler said. “We are very well attuned...

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