Study: About two-thirds of the 41 percent increase between 2011 and 2019 in the share of hospital discharges coded as the highest severity was associated with upcoding.
Among patients discharged to a skilled nursing facility (SNF) during 2018–19, MA enrollees had risk scores that averaged 4.1 percent higher, with about 60 percent of that increment associated with chart reviews.
About one-quarter of the risk-score gap between MA and traditional Medicare from 2017 to 19 is due to the failure to consistently capture chronic conditions in fee-for-service claims.
Source: Health Affairs