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Medicare Advantage, Direct Contracting, and the Medicare ‘Money Machine,’
- lalaland1125 5y agoThis is a beautiful example of how incentives drive organizational activity. In Medicare Advantage, each provider is paid according to how many ICD codes their patients have. This causes providers to "juice" the numbers by giving their patients a ton of ICD codes. > Given the dollar magnitude, risk-score gaming becomes a central part of every MA plan’s strategy. The starting point is to get as many diagnosis codes as possible. An entire industry been created to do just that, leading to billion dollar valuations for firms, like Signify Health, that provide analytical tools to enable coding efforts or make home visits for plans and providers. Most Plans now use Artificial Intelligence (AI) HCC Tools to identify coding opportunities.