Some Medicare advantage Diagnosis tactics, Diage WealthGroup made insurers like a rich $ 33 billion

Since the UNITEDHEALTHCARE CEO is high-profile killing Brian Thompson Last year, health insurers faced a serious check and increased the wrath of the people. Now a New research He can fan the flames. It plans to take differential coding samples between Medicare Preference (MA) and Traditional Medicare (TM) plans, $ 13.9 billion or a total of $ 33 billion, or to a total of 42% plans UnitedHealth group.

These findings, add a concrete context since 2021 Past research Medicare has found evidence of higher diagnostic “coding intensity” than traditional Medicare, than traditional Medicare for comparable beneficiaries. Therefore, the Congress evaluated the Medicare Payment Commission, Medicare, if registered in Traditional Medicare, if they register this difference for $ 50 billion in 2024, more expend.

Medicare advantage plans, according to new findings, get less and less salaries for healthy members that provide more and less diagnosis for patient members. However, there are no research so far, evaluated the amount of additional income from the authors, each insurer.

“The most important accepting, some Medicare advantage is more aggressively than other insurers, more aggressively, more aggressively, and the multi-billion dollar dollars are made in addition to many billion dollars,” Research author Richarnia University of California University of California University of Family Medicine. “As a result, most of those who determine the successful insurers in Medicare advantage, the insurer said that the insurer is high quality and so effective, but how aggressive in coding.” He pointed out $ 13.9 billion, which is grown by the Downhisiary group, which benefits for $ 0.5 billion for the Kaiser for $ 0.5 billion.

A spokesperson for attention group refused to comment Fortune In findings, refer to the non-commercial side of our publication Better Medicare AllianceWyatt Decker counts as a chief doctor, a member of the United Health Group.

“This is a defective apple orange analysis,” Kaitlyn Saal-Ridpath, Better Medicare Alliance Vice President Luck. “Medicare Fore-Service Medicare is not adjusted for clinical or demographic differences between the coding or Medicare advantage and clinical or demographic differences for the service.

Saal-Ridpath also notes that the study is funded by Arnold enterprises Keeps confidence These insurers are excessive.

Kronick noted that Arnoldun did not accept “in the design or results of research or results or results” or the results, and researchers obviously admitted it. ” In addition, “no analysis is not perfect, but also is more important to measure the differences between the mediocre and the coding of coding between the traditional, the fact that some insurers are more aggressive than other insurers, resulting in many billion dollars.”

In 2024, Medicare benefited Medicare more than half of the beneficiaries (54%), According to the KFFaccounting$ 462 billionGeneral Federal Medicare spending. In addition, registration in MA, with a palm, a palm and a palm and Humana Accounting for half of all MA (47%).

Recently, there was a change in the right. Usually after 65 years of age, in you Two Medicare Options-Traditional Medicare (parts One, Band Dand often a Medigap Plan) or a special health insurer Medicare Preference PlanAlso called Part C, people who have retired health benefits from past employers are not often selected. Instead, they say they should be written Medicare Preference PlanWith a network of limited doctors and hospitals or completely lose their retirement health benefits.

At the same time, The final research shows The applicants of this MA are healthier, because people in need of medical care should want less to accept the restrictions on the MA (such as low-permitted networks and limited networks).

How did researchers come to findings about Medicare

Researchers analyzed the risk scores represented by a certain patient or patient with a certain patient or patient with a certain patient or patient as patient with a certain health conditions based on certain health conditions. In addition, risk scores related to risk scores within 24 months, during the two years of a diagnosis coded in the years in the years, I have analyzed the impact of the coding of the diagnosis in the years and a new diagnosis of risk scores.

What they find, the average MA risk score (1.26) is 18.5% higher than the average TM risk account (1.07).

The ratio of endurance and new event ratio has changed among insurers, researchers, researchers, UNITE CETH GROUP’s average of 2021 risk of 2021.

The findings write the problem, Dr. J. Michael responded to a study at the McWilliams, Research Medical School and Brigham and Brigham and Women’s Hospital Accompanied editorialIt was published on Monday The anniversary of internal medicine. 

“Medicare advantage (MA) is a mass problem of risk regulatory system,” he said.

“It is paid to pay the diagnosis codes for insurers to the benefit, in addition to the financial problems of Medicare, to pay ten billion dollars in the traditional Medicare (TM) for $ 1 billion dollars. “However, the problem is deeper, because incentives for the diagnosis of the code are even more intensively, further violate the competition and resource separation within the MA.”

Among the many problems of researchers, McWilliams continues

However, it would be a hold of solving the problem.

“The seizure will say,” McWilliams say, “said McWilliams,” said McWilliams, “said, reducing payments or higher premiums or less generous benefits.

Because Medicare preferred insurers while maintaining a significant part of subsidies and deposits, they pass through a great share for refresher. “As the subsidies grow more generous, the MA served as a back planning mechanism to solve the value of the TM for a long time (eg, maximum of pocket maximum), and benefits from the pocket expenditures in MA.

Payment subsidies point out, as changed by risk regulation reform and other proposed other measures, “It is very desirable for the elderly compared to the traditional benefits, politicians must fight this trade.”

More about Medicare:

• Traditional Medicare or Medicare advantage? Some retirees are not allowed to choose
• If you are not happy with your Medicare Preference Plan, experts offer these recommendations to find better benefits
• Original Medicare does not cover most dental work, but the coverage has 4 other ways

This story was first displayed Fortune.com

Source link