Abstract Introduction The intensity of diagnostic coding in Medicare Advantage relative to Original Medicare plays an important role in Medicare’s fiscal costs due to its impact on risk adjustment payments. In this article, we provide new estimates of coding differentials that differ from other prominent estimates and incorporate recent policy changes. Methods CMS staff recalculated payment year 2022 national average enrollment-weighted risk scores for Medicare Advantage and Original Medicare using the newly implemented v28 risk adjustment model and a demographic-only risk adjustment model. Following the Demographic Estimate of Coding Intensity methodology, we estimate the difference in risk scores due to differences in health status between Medicare Advantage and Original Medicare. Results Using a comparable methodology as other widely cited research, we estimate 1.5-2.0 percent of “uncorrected” coding in Medicare Advantage relative to Original Medicare in 2022 after accounting for statutorily mandated payment adjustments and recent changes to the Medicare Advantage risk adjustment model. Conclusion Compared to alternative estimates of roughly 10 percent, our lower estimated uncorrected coding in Medicare Advantage suggests that prior policy actions may have affected federal spending in Medicare Advantage. These findings can help inform discussion of the overall fiscal balance between Medicare Advantage and Original Medicare.
Albanese et al. (Sat,) studied this question.