CMMI taking hard look at Medicare Advantage coding practices and impact on payment models – FierceHealthcare
The center for Medicare and Medicaid Innovation (CMMI) Desires to commerce or enhance its hazard adsimplyment techniqueology after considerations of Medicare Benefit plans upcoding to get greater costs, the center’s director said.
CMMI Director Liz Fowler, Ph.D., detailed how the center plans to shift The primary goal in its cost fashions to care supply all by way of a webinar Wednesday sponsored by the advocacy group Usa of Care. The remarks come as scrutiny over MA coding practices has loomed over the profitable market.
“There was Tons written Regarding The power To work together in coding and upcoding positive elements and it’s a Method of maybe getting greater costs or greater costs with out truly delivering care,” Fowler said. “We’re very properly attuned To A pair of of the tendencies we are seeing.”
Critics have charged that MA plans can draw overcosts from Medicare by submitting pointless evaluation codes and inflating hazard scores Which will Finish In further subsidies and extreme quality bonuses for the payers.
Fowler said the center is Making an try To deal with hazard adsimplyment in its ongoing fashions.
“It’s actually essential To Make constructive that innovation is round care supply And by no means simply greater strategies of gaming the well being system and upcoding,” she said.
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Fowler talked about that in Definitely one of many fashions, CMMI has an general constraint on hazard rating progress utilized throughout The complete program. Furtherextra It is utilized individually to particular mannequin individuals.
“A pair of Of these classes In the event that they’re worthwhile Might be utilized to [Medicare …….
