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Coding Intensity Options: The Perspective of Safety Net Health Plans
A new ACAP report highlights why policy changes to Medicare Advantage (MA) coding intensity must reflect the diversity of plans in the D-SNP and MA-PD space and emphasizes that effective coding intensity policies must balance achieving policy goals for accurate MA spending while also accounting for the heterogeneity in the MA and D-SNP markets.
Coding Intensity Options: The Perspective of Safety Net Health Plans, shares the following policy recommendations and options for consideration:
- Continue Allowing D-SNPs to Submit Diagnostic Codes Obtained Through HRAs and Chart Reviews
- Assess Model Enhancements to Improve the Accuracy of the MA Risk-Adjustment Model and Reduce Reliance on Annual Diagnostic Capture
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- Evaluate the Feasibility and Impact of Adding SDOH-related Metrics to the MA Risk-Adjustment Model
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- Assess Inclusion of Two Years of Diagnostic Data for MA Payments
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- Evaluate Adding a High-Cost Pool to the MA Risk-Adjustment Model
- Evaluate Replacing the Current Coding Intensity Adjuster with a Tiered Coding Adjustment System
Read the report in full via the sidebar to the right.