Article

GAO: Medicare Overpaying for Medicare Advantage

A study by the Government Accountability Office finds differences in diagnostic coding between Medicare Advantage plans and traditional Medicare fee-for-service coverage.

These differences mean that Medicare Advantage beneficiary risk scores in 2010 were 4.8 percent to 7.1 percent higher than if those beneficiaries were continuously enrolled in fee-for-service, according to GAO, a congressional investigatory agency. And the higher scores translated in 2010 to $3.9 billion to $5.8 billion in higher payments to Medicare Advantage plans. Further, the coding differences increase over time, suggesting higher financial impacts in 2011 and 2012.

CMS estimates a lower level, 3.4 percent, of higher beneficiary risk scores in Medicare Advantage plans, translating to $2.7 billion in excess payments. GAO contends the CMS methodology does not include more current data, trending coding differences over time, or accounting for such characteristics as sex, health status, Medicaid enrollment status, beneficiary residential location, and disability.

Read more at:http://tinyurl.com/6t65zft

Source: Health Data Management

Related Videos
dr ian neeland
dr manisha jhamb
dr john m. o'brien
Ali Khawar
Neil Goldfarb, CEO, Greater Philadelphia Business Coalition on Health
Screenshot of Mary Dunn, MSN, NP-C, OCN, RN, during a video interview
Inma Hernandez, PharmD, PhD, professor at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences
Carrie Kozlowski
Carrie Kozlowski, OT, MBA
Related Content
AJMC Managed Markets Network Logo
CH LogoCenter for Biosimilars Logo