Diagnosis Added To Some Medicare Advantage Enrollees’ Chart Review Record Led To Increased Federal Payments

Among enrollees who have at least one chart review record, 17% had a diagnosis added that increased payments from the Centers for Medicare & Medicaid Services (CMS) to their Medicare Advantage (MA) plan, according to a recent analysis by KFF, a non-profit organization focused on health policy.

In comparison, a much smaller proportion (just over 1%) of MA participants had condition categories deleted from risk adjustment calculations following chart review-based diagnosis removals.

To reach these conclusions, researchers analyzed a sample of 2022 MA encounter data (excluding prescription drug data). A total of 62% of MA enrollees (18 million . . .