PulseExploreJournal ClubDebatesTrendingResearchersJournals
Instagram
HomeExploreJournal ClubTrending
Synapse
⌘+K
Synapse
January 22, 2026Health Affairs Scholar2 citationsOpen Access

Updated Analysis of Diagnostic Coding Patterns in Medicare Advantage

An Updated Analysis of Coding Pattern Differences in Medicare Advantage

View Full Paper

Authors

JAJoe AlbaneseAAAlec AramandaJBJohn Brooks

Discussion

Loading...

Member takes

Overview

Analysis reveals increased coding differentials in Medicare Advantage, suggesting implications for fiscal costs.

Key Points

  • This analysis aims to estimate differences in diagnostic coding intensity between Medicare Advantage and Original Medicare.
  • Recalculation of risk scores for Medicare Advantage and Original Medicare for payment year 2022.
  • Utilization of the v28 risk adjustment model and a demographic-only risk adjustment model.
  • Application of the Demographic Estimate of Coding Intensity methodology to analyze health status differences.
  • Estimated uncorrected coding in Medicare Advantage is 1.5-2.0 percent relative to Original Medicare in 2022.
  • Estimates account for mandated payment adjustments and recent policy changes in the risk adjustment model.
  • Findings suggest prior estimates of around 10 percent may be overstated, indicating potential impacts on federal spending.
Ask AI
Helpful
Bookmark
Share
View Full Paper

Cite This Study

Albanese et al. (2026) studied this question.

synapsesocial.com/papers/6971bdad642b1836717e2659https://doi.org/10.1093/haschl/qxag010
Ask AI
Helpful
Bookmark
Share
View Full Paper