An analysis by ACHP shows that gaming within the Medicare Advantage program by large national carriers persists, wasting tens of billions of taxpayer dollars each year.
The higher the risk score, the more money paid to the insurer.
The gap isn’t a mistake; it’s the result of coders capitalizing on complexities in the program for financial gain. These wide variations stifle competition and leave tens of millions of consumers nationwide disadvantaged.
CARE, NOT CODES: A Bold Plan for Simplifying Medicare Advantage Risk Adjustment
It’s time for change. By simplifying risk adjustment to focus on demographics and a small set of substantiated health conditions – instead of thousands of potential diagnoses – Medicare payments will reflect true patient care costs.
Under ACHP’s proposal, consumers benefit by having access to the plans that best meet their needs, rather than those with the glitziest marketing campaigns and other goodies that do not improve health. Providers benefit from less administrative burden, allowing them to focus on the patient and not paperwork. And taxpayers benefit by saving tens of billions of dollars every year in wasteful upcoding.
Over the past two years, ACHP has spearheaded efforts to improve the popular Medicare Advantage program. Through its MA for Tomorrow initiative, ACHP has identified a range of commonsense proposals to secure and refine the Medicare Advantage program for future generations.
