ArticleHealth services research2025
Identifying Coding Intensity in Medicare Advantage Through Switchers.
Article in Health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 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
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.
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Who cites it
6 citing papers in PubMed.
- Advancing the measurement of favorable selection in Medicare Advantage: evidence from encounter data.Health affairs scholar · 2026Article
- Surgical Outcomes and Postacute Care Use Among Rural Medicare Advantage Beneficiaries.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- Exposure to the new Medicare Advantage risk adjustment model varies across insurers.Health affairs scholar · 2026Article
- The importance and challenge of comparing stroke care, utilization and outcomes in Medicare Advantage and Fee-for-Service Medicare: a narrative review and vision for the future.Journal of comparative effectiveness research · 2026Review
- Incidence, Persistence, and Steady-State Prevalence in Coding Intensity for Health Plan Payment.medRxiv : the preprint server for health sciences · 2025Article
- Identifying Coding Intensity in Medicare Advantage Through Switchers.Health services research · 2025Article
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
objectiveTo estimate the extent of differential coding of health risk in traditional Medicare (TM) compared with Medicare Advantage (MA). STUDY SETTING AND
designPayments to MA plans are based on reported medical conditions, and research has shown the number and severity of diagnoses are larger when beneficiaries are enrolled in MA plans rather than TM. We compare the risk scores of Medicare beneficiaries who switch from TM into MA over the 2013-2021 period to the scores of beneficiaries who stay in TM, incorporating heterogeneous treatment effects across switching cohorts and over time. DATA SOURCES AND ANALYTIC SAMPLE: We use a 10% sample of Centers for Medicare and Medicaid Services data containing individual risk scores and enrollment status for 2012-21. After applying exclusion criteria, our sample consists of 1,911,968 beneficiaries with data available for each year. We also link administrative data to the Medicare Current Beneficiary Survey to assess measures of health status. PRINCIPAL
findingsWe find the risk scores of switchers to MA were 0.120 points (12.4%; 95% confidence interval [CI]: 12.0%-12.8%) higher than stayers in the second year, 0.166 points (17.2%; 95% CI: 16.7%-17.6%) higher in the third year, and 0.216 points (22.3%; 95% CI: 21.7%-22.9%) higher by the sixth year after switching. Averaged over all MA enrollees in 2021, our estimates suggest coding intensity in MA led to risk scores that were 18.6% higher than for comparable enrollees in TM.
conclusionsOur estimates of coding intensity are at the higher end of the range in the prior literature while addressing concerns of endogenous switching. Our estimates of increasing coding over time and across enrollment cohorts can help inform decisions regarding adjustments to MA payments for coding intensity.
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