1 in 6 Medicare Advantage Enrollees Had a Chart Review That Increased Federal Payments to Their Insurer

The practice has drawn bipartisan scrutiny.

View in browser NEW & NOTEWORTHY 1 in 6 Medicare Advantage Enrollees Had a Diagnosis Added on a Chart Review That Increased Federal Payments to their Medicare Advantage Plan A new KFF analysis examines chart reviews in Medicare Advantage and explains how the practice can boost federal payments to the insurance companies that administer the private plans.   It finds that 1 in 6 (17%) Medicare Advantage enrollees had a diagnosis added on a chart review that increased federal payments to the insurer who ran their plan. Less than 1% had a diagnosis removed. More broadly, the analysis of Medicare Advantage encounter data for 2022 finds that six in ten (62%) Medicare Advantage enrollees had at least one chart review record that year. Medicare Advantage insurers conduct chart reviews to determine if the information submitted by providers is consistent with the person's medical records. Chart reviews may improve an insurer's understanding of a person's health care needs, but also lead to higher payments from the federal government when conditions are added because, in general, Medicare Advantage plans are paid more for people with more health conditions.   Adjusting payments based on an enrollee's diagnosed health conditions provides an incentive for insurers to document diagnoses more comprehensively than is done for traditional Medicare beneficiaries. That practice has drawn bipartisan criticism in Congress, which has led to proposed legislation to rein in the higher spending associated with coding practices. Other research has found that chart reviews, which are not used in traditional Medicare, are the largest contributor to higher payments to Medicare Advantage plans, and according to the Medicare Payment Advisory Commission generated an estimated $24 billion in additional payments to plans in 2023. Also released today is a KFF explainer on how the federal government pays Medicare Advantage plans. The brief includes an overview of policy options to change the payment system, as well as a glossary of terms related to Medicare Advantage payment policy. CONTACT:   Chris Lee | 202.654.1403 | ChrisL@kff.org    When citing our work, please note our name is KFF, which is our legal operating name. We should be cited as KFF, a nonprofit health policy research, polling, and news organization. We no longer use the name Kaiser Family Foundation.  Did someone forward this to you? Sign up for emails from KFF. This email was sent to awesomeblogger71.lificletter@blogger.com. Update your email preferences to choose the types of emails you receive. Or, permanently unsubscribe from all future emails. Need assistance? Email subscriptions@kff.org; do not reply to this email. The independent source for health policy research, polling, and news. KFF, 185 Berry Street, Suite 2000, San Francisco, CA 94107