Becker's Healthcare April 5, 2023
Two Senators are introducing legislation aimed at reducing Medicare Advantage overpayments.
Sen. Bill Cassidy, MD, a Louisiana Republican, and Sen. Jeff Merkley, an Oregon Democrat, introduced the No Unreasonable Payments, Coding, or Diagnoses for the Elderly, or No UPCODE, act March 27.
The proposed legislation would target upcoding through several mechanisms, including
- Shifting to a risk-adjustment model that uses two years of diagnostic data instead of one year.
- Limiting the ability to include old or unrelated medical conditions in the cost of care.
- Ensuring Medicare is only charged for treatment related to relevant diagnosis codes.
- Closing the gap between how patients are coded in traditional Medicare and Medicare Advantage.
In a news release, Dr....
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