ArticleHealth services research2024
The mechanics of risk adjustment and incentives for coding intensity in Medicare.
Article in Health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 9 citations in OpenAlex.
- Risk Adjustment in the Medicare Advantage Population Using Encounter Data.Health services research · 2026Article
- Evaluating Cardiovascular Devices Using Observational Analyses.Circulation · 2026Review
- Exposure to the new Medicare Advantage risk adjustment model varies across insurers.Health affairs scholar · 2026Article
- Incidence, Persistence, and Steady-State Prevalence in Coding Intensity for Health Plan Payment.medRxiv : the preprint server for health sciences · 2025Article
- Understanding and Addressing Upcoding.Health services research · 2025Article
- Medicare Advantage Has Lower Resource Use and Better Quality of Care than Traditional Medicare.American journal of health economics · 2025Article
- Potentially Inappropriate Medication Use Among Patients With Dementia in Traditional Medicare and Medicare Advantage.Medical care · 2025Article
- Validation of Medicare Advantage Claims for Long-Term Outcome Assessment in Low-Risk Aortic Valve Replacement.Circulation. Cardiovascular quality and outcomes · 2025Article
- Outcomes for Dual-Eligible Beneficiaries With Dementia in Special Needs Plans and Other Medicare Advantage Plans.JAMA network open · 2025Article
- Coding intensity variation in Medicare Advantage.Health affairs scholar · 2025Article
- The mechanics of risk adjustment and incentives for coding intensity in Medicare.Health services research · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo study diagnosis coding intensity across Medicare programs, and to examine the impacts of changes in the risk model adopted by the Centers for Medicare and Medicaid Services (CMS) for 2024. DATA SOURCES AND STUDY
settingClaims and encounter data from the CMS data warehouse for Traditional Medicare (TM) beneficiaries and Medicare Advantage (MA) enrollees. STUDY
designWe created cohorts of MA enrollees, TM beneficiaries attributed to Accountable Care Organizations (ACOs), and TM non-ACO beneficiaries. Using the 2019 Hierarchical Condition Category (HCC) software from CMS, we computed HCC prevalence and scores from base records, then computed incremental prevalence and scores from health risk assessments (HRA) and chart review (CR) records. DATA COLLECTION/EXTRACTION
methodsWe used CMS's 2019 random 20% sample of individuals and their 2018 diagnosis history, retaining those with 12 months of Parts A/B/D coverage in 2018. PRINCIPAL
findingsMeasured health risks for MA and TM ACO individuals were comparable in base records for propensity-score matched cohorts, while TM non-ACO beneficiaries had lower risk. Incremental health risk due to diagnoses in HRA records increased across coverage cohorts in line with incentives to maximize risk scores: +0.9% for TM non-ACO, +1.2% for TM ACO, and + 3.6% for MA. Including HRA and CR records, the MA risk scores increased by 9.8% in the matched cohort. We identify the HCC groups with the greatest sensitivity to these sources of coding intensity among MA enrollees, comparing those groups to the new model's areas of targeted change.
conclusionsConsistent with previous literature, we find increased health risk in MA associated with HRA and CR records. We also demonstrate the meaningful impacts of HRAs on health risk measurement for TM coverage cohorts. CMS's model changes have the potential to reduce coding intensity, but they do not target the full scope of hierarchies sensitive to coding intensity.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.