Becker’s Hospital Review summarized a recently released report from The Wall Street Journal that found Medicare Advantage plans collected $50 billion from diagnoses added to patients’ charts between 2018 and 2021, a third of which were added during home visits – even as the Medicare Payment and Advisory Commission recommends against insurers being paid for diagnoses added through home visits.

From the article:
By Rylee Wilson

Insurers made billions from diagnoses added to Medicare Advantage beneficiaries’ charts during home visits, The Wall Street Journal found in an investigation published Aug. 5.

Previous reporting from the Journal found that MA insurers made $50 billion from diagnoses added to patients charts between 2018 and 2021. Many of these diagnoses were “questionable,” according to the Journal.

Around a third of these diagnoses were added during home visits, the Journal reported. The federal government pays Medicare Advantage plans a rate per beneficiary based on their diagnoses.

The federal government will spend $83 billion more on Medicare Advantage beneficiaries than if they were enrolled in fee-for-service Medicare, according to estimates from the Medicare Payment and Advisory Commission. Coding intensity in MA will be 20% higher than in fee-for-service in 2024, according to the commission, which advises the federal government on Medicare issues.