MedPAC: The majority of Medicare recipients will be on MA by 2023, but coding problems continue to flourish


Most Medicare recipients in Parts A and B are expected to be enrolled in Medicare Advantage plans next year, but spending on the plans will continue to exceed the traditional service fee, a congressional advisory panel noted.

The Medicare Payment Advisory Commission (MedPAC), a panel that makes recommendations to Congress on Medicare policy, released new results on Friday on the program, which has grown in popularity in recent years. It also continues to raise alarms about practices that plans have done as coding that have increased Medicare spending.

MedPAC found that 46% of Beneficiaries in Parts A and B were enrolled in MA plans, and that figure is expected to exceed 50% by 2023.

“Despite a reduction in MA prices, MA registration has continued to grow rapidly,” said Luis Serna, a MedPAC employee, during the panel meeting on Friday.

The panel also found that for this year, 99% of Medicare recipients have access to at least one plan, and 98% of them can choose a plan with some D benefit.

But MedPAC found that the explosion of growth has not also led to more savings for traditional Medicare.

The panel found that spending in MA this year will be 4% higher than the fee for the Medicare service after considering coding methods such as coding, leading to higher quality bonuses for plans.

“MA plans have a financial incentive to document more diagnoses than providers within fee-for-service Medicare, leading to higher MA risk scores and greater Medicare expenses for the beneficiary enrolling in MA,” said staff member Andy Johnson, Ph.D. D.

RELATED: The study examines differences in denial of coverage in traditional Medicare, MA

In 2020, MedPAC found that the MA risk score was 9.5% higher than recipients of fees for services with similar health status.

Centers for Medicare & Medicaid Services reduces the risk score to compensate for any coding differences, but the adjustment was only 5.9%, Johnson said.

“The remaining difference made MA risk points 3.6% higher, generating approximately $ 12 billion in payments to MA plans in addition to what Medicare would have spent for the same beneficiaries in Medicare fee-for-service,” Johnson said.

It also estimated, using data from the Department of Health and Human Services’ Office of the Inspector General, that nearly two-thirds of excess payments to MA plans are due to map surveys and health risk assessments.

Limiting such practices can help reduce overpayments and improve quality, Johnson added.

MA has become a huge lucrative space for insurance companies, with more payers joining the program for the coverage year 2022.

Proponents of the program praised the results, which showed MA’s enrollment growth estimated for next year, but rejected the parts of the analysis that shed light on the coding methods.

The Better Medicare Alliance legal group tweeted a study it commissioned from Milliman that showed that total monthly fees are slightly higher than total MA payments.

“We will continue to insist on a proper, holistic understanding of MA spending that stands for its enhanced benefits, better health outcomes, [and] consumer savings to a proportionately more versatile, lower income, [and] a socially disadvantaged population than FFS Medicare “, the group tweeted.



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