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 ...

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 ...

Andrew S. Oseran, MD, MBA, MSc, hypothesizes that higher Medicare Advantage (MA) risk scores may result from either a more accurate capture of beneficiaries' comorbidities or inappropriate "upcoding" ...

In five states over nearly a decade, hospitals have increased how frequently they document patients as needing the highest intensity care, which has led to hospitals receiving billions in extra ...

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 ...

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 ...

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 ...