January 22, 2025
ARC analysts provided the data analysis and co-authored a paper identifying which specific chronic conditions and provider practices are most responsible for coding differences between Traditional Medicare and Medicare Advantage (MA). This paper identifies 10 chronic conditions which account for nearly all of the MA coding differences. Additionally, we estimated that the impact of conditions captured only through chart review and home health risk assessments (HRAs) accounts for roughly one-third of MA coding differences. In the paper, we discuss policy considerations reacting to these findings, including potential implications of eliminating or reducing the impact of these 10 conditions or chart reviews and HRAs on risk scores. The link below can access the article:
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2024.00369