Fierce Healthcare May 9, 2024
Medicare Advantage plans have come under fire for upcoding that can increase the payouts they receive, and regulators point to health risk assessments as a likely culprit in this increase in coding intensity.
A new study published this week in Health Affairs adds to the body of evidence around these assessments. The analysis, led by researchers at Brown University, dug into encounter data from 2019 and found that 44.4% of Medicare Advantage beneficiaries had received at least one health risk assessment.
Within the group that had undergone a risk assessment, hierarchical condition categories (HCC) scores increased by 12.8%, and more than one in five of these enrollees had at least one additional diagnosis captured in the risk assessment.
The researchers...
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