Becker's Healthcare March 8, 2023
Provider groups are joining in payers’ concerns about CMS’ proposed changes to Medicare Advantage risk adjustments and diagnosis coding.
In comments submitted to CMS March 6, the American Medical Group Association wrote that the agency should delay the implementation of the proposed switch to shifting MA’s diagnosing coding to ICD-10 and reconsider removing certain codes from the Hierarchical Condition Categories model.
Risk adjustment is the system used by CMS to pay Medicare Advantage plans based on each beneficiary’s health risk. The risk adjustment changes are part of a suite of changes — including shifting MA’s diagnosis coding from ICD-9 to ICD-10 in 2024, which is used by more physicians, — the agency proposed in a notice issued Feb....
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