In its most recent report to Congress, MedPac projects that payments to Medicare Advantage in 2025 will be about 20% more traditional Medicare. This report along with the recent confirmation hearing of Dr. Oz has brough renewed attention to the No Upcoding Act which was introduced by Senator Bill Cassidy (R-LA) which calls into question the use of retrospective chart reviews and health risk assessments for risk adjustment purposes.
We know for sure that Medicare Advantage and the diagnosis codes used to drive payments to health plans will continue to be under scrutiny.
Is your program ready? CoventBridge is here to help. We offer end to end Risk Adjustment program assessments. If interested, please contact us at: marketing@coventbridge.com
S.1002 – 118th Congress (2023-2024): No UPCODE Act | Congress.gov | Library of Congress (Congress.gov)
March 2025 report to the Congress–Chapter 11: The Medicare Advantage program: Status report (The Medicare Advantage program: Status report, March 2025, MedPac)
