ArticleHealth services research2021
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
Article in Health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
17 citing papers in PubMed, 26 citations in OpenAlex.
- Risk Adjustment in the Medicare Advantage Population Using Encounter Data.Health services research · 2026Article
- Mandatory Value-Based Payment Programs and Hospital Administrative Costs.JAMA health forum · 2026Article
- Advancing the measurement of favorable selection in Medicare Advantage: evidence from encounter data.Health affairs scholar · 2026Article
- Increased payments to Medicare Advantage plans for dually eligible beneficiaries.The American journal of managed care · 2026Article
- Provider Attribution in Medicare: Challenges and Solutions.Health services research · 2026Article
- Do MA plans follow incentives to attract enrollee groups with new supplemental benefits?Health affairs scholar · 2025Article
- Private Medicare plans' responses to benchmark changes and competition before and after the Affordable Care Act's payment cuts.Health services research · 2025Article
- Coding intensity variation in Medicare Advantage.Health affairs scholar · 2025Article
- Estimation of the Eligible Population For Resmetirom Among Adults in the United States for Treatment of Non-Cirrhotic NASH with Moderate-to-Advanced Liver Fibrosis.Advances in therapy · 2024Article
- Association Between the Medicare Advantage Quartile Adjustment System and Plan Behavior and Enrollment.JAMA health forum · 2024Article
- Medicare advantage and dialysis facility choice.Health services research · 2023Article
- Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017.Health affairs (Project Hope) · 2023Article
- Evaluation of Potentially Avoidable Acute Care Utilization Among Patients Insured by Medicare Advantage vs Traditional Medicare.JAMA health forum · 2023Article
- Risk Adjustment And Promoting Health Equity In Population-Based Payment: Concepts And Evidence.Health affairs (Project Hope) · 2023Article
- Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries.Risk management and healthcare policy · 2023Article
- The effects of coding intensity in Medicare Advantage on plan benefits and finances.Health services research · 2021Article
- Commentary on: The effects of coding intensity in Medicare advantage on plan benefits and finances.Health services research · 2021Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. DATA SOURCES/STUDY
settingMA plan characteristics and administrative records from the Centers for Medicare and Medicaid Services (CMS) for the sample of beneficiaries enrolled in both MA and Part D between 2008 and 2015. Medicare claims and drug utilization data for Traditional Medicare (TM) beneficiaries were used to calibrate an independent measure of health risk. STUDY
designCoding intensity was measured by comparing the CMS risk score for each MA contract with a contract level risk score developed using prescription drug data. We conducted regressions of plan outcomes, estimating the relationship between outcomes and coding intensity. To develop prescription drug scores, we assigned therapeutic classes to beneficiaries based on their prescription drug utilization. We then regressed nondrug spending for TM beneficiaries in 2015 on demographic and therapeutic class identifiers for 2014 and used the coefficients to predict relative risk. PRINCIPAL
findingsWe found that, for each $1 increase in potential revenue resulting from coding intensity, MA plan bid submissions declined by $0.10 to $0.19, and another $0.21 to $0.45 went toward reducing plans' medical loss ratios, an indication of higher profitability. We found only a small impact on beneficiary's projected out-of-pocket costs in a plan, which serves as a measure of the generosity of plan benefits, and a $0.11 to $0.16 reduction in premiums. As expected, coding intensity's effect on bids was substantially larger in counties with higher levels of MA competition than in less competitive counties.
conclusionsWhile coding intensity increases taxpayers' costs of the MA program, enrollees and plans both benefit but with larger gains for plans. The adoption of policies to more completely adjust for coding intensity would likely affect both beneficiaries and plan profits.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.