Aligning The MedPAC And CMS Estimates Of Coding Intensity: The Importance Of The Risk Model And Trend Michael E. Chernew Andy Johnson Paul B. Masi Karen Stockley

https://www.healthaffairs.org/content/forefront/aligning-medpac-and-cms-estimates-coding-intensity-importance-risk-model-and-trend The growth of the Medicare Advantage (MA) program to over half of eligible Medicare beneficiaries has made MA payment a salient part of Medicare policy discussions. Those discussions often focus on aspects of the risk adjustment system—which adjusts Medicare’s payments to plans based on enrollees’ recorded health conditions and demographic information. Because FFS claims are used to both calibrate the risk adjustment model and set MA benchmarks, greater coding intensity in MA, whether accurate or not, raises Medicare spending and thus beneficiaries’ Part B premiums, which are calculated to cover about 25 percent of Part B expenses.