Shifting from reducing MA capitation by an across-the-board coding intensity adjustment factor to Medicare Advantage organization (MAO)-specific adjustment factors would improve the financial outlook ...
Medicare Advantage plans may have received higher payments as a result of upcoding from 2010 to 2014, according to new research published by Health Management, Policy & Innovation. The study's authors ...
In the complicated world of hospital billing, there’s a fine line between maximizing reimbursement and gaming the system. A new study shows a troubling trend as hospitals increasingly code for “sicker ...
Recent studies document a substantial increase in emergency department (ED) spending in the past decade, even though the number of ED visits per capita has remained relatively stable. Price increases ...
At the start of 2023, an estimated 2.5 million Americans age 65 and older began using Medicare Advantage programs. Some made this choice in response to aggressive marketing campaigns. This brings the ...
The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes ...
High-intensity billing during "treat and release" emergency department stays rose significantly from 2006 to 2019, and was partially fueled by factors such as changes in case mix and service offering ...
In MA, the government pays insurers a set amount to manage the care of Medicare beneficiaries. Payments are adjusted based on risk scores representing beneficiaries demographics, location and health ...
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