Becker's Healthcare March 13, 2023
Payers and providers have expressed concerns about CMS’ proposed changes to Medicare Advantage risk adjustments and diagnosis coding.
Groups representing payers have said the proposed rate adjustments will force plans to either cut benefits or raise costs, and providers have said the agency’s overhaul of the diagnostic coding system in Medicare Advantage could have unintended consequences for patient care and physician reimbursements.
CMS’ proposed changes to risk adjustment, which is the system used by CMS to pay Medicare Advantage plans based on each beneficiary’s health risk, include shifting MA’s diagnosis coding from ICD-9 to ICD-10 in 2024, which is used by more physicians. The agency proposed this change and others in a notice issued Feb. 1.
CMS...
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