KFF Analysis Highlights Medicare Advantage Diagnosis Additions Impacting CMS Payments

A recent analysis by the Kaiser Family Foundation (KFF) reveals that among Medicare Advantage (MA) enrollees with at least one chart review, 17% had new diagnoses added that resulted in higher payment rates from the Centers for Medicare & Medicaid Services (CMS) to their MA plans. Conversely, only about 1% experienced deletion of condition categories that lowered risk adjustment payments. The study reviewed 2022 MA encounter data covering 62% of enrollees, excluding prescription drug data, highlighting key trends in risk adjustment documentation and its impact on MA plan reimbursements.