Summary

Description

In 2004, Medicare implemented a risk-adjustment system that pays Medicare Advantage (MA) plans based on diagnoses reported for their enrollees, giving the plans an incentive to identify more diagnoses. As reported in the article, Measuring Coding Intensity in the Medicare Advantage Program, published in Volume 4, Issue 2 of Medicare and Medicaid Research Review, each year since 2004 the average MA risk score increased faster than the average fee-for-service (FFS) score. This relative increase in scores largely reflects changes in diagnostic coding, not real increases in the morbidity of MA enrollees, as survey-based data shows no trend in MA risk scores relative to FFS scores. Increases in risk scores vary widely by MA contract, with some contracts coding very similarly to traditional Medicare and others more intensively than the MA average.