Fierce Health Payers October 15, 2021
Medicare open enrollment kicked off Friday with more Medicare Advantage plans to choose from but with renewed criticism that insurers are gaming risk adjustment practices to inflate profits.
While more and more insurers are expanding their presence in the MA marketplace, private Medicare plans are facing heightened scrutiny over risk adjustment and comprehensive diagnostic coding. But industry advocates counter that the criticisms of MA are unfair and that patients get better care in MA plans compared to traditional Medicare.
A series of articles in Health Affairs published late last month by former Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick and former Trinity Health CEO Richard Gilfillan sheds light on coding practices that have made the MA space...
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