Sunday Links

You’re Amazing!


Everybody’s up in arms about the return of extrapolation to Medicare Advantage internal audits.

As mentioned in my newsletter

this week, the audits are still internal, the results self-reported and enforcement increasingly difficult in this legal environment.

Short of obvious fraud, the only thing these changes represent is a marketing opportunity for compliance companies.

Be honest and all will be well.




How does Risk Selection Respond to Risk Adjustment?

Risk Adjustment ends up costing the government more per beneficiaries—probably because the government was getting off cheap before.



The Comparative Advantage of Medicare Advantage

Among select risk-associated conditions, diagnostic coding intensity is higher for Medicare Advantage patients than those in traditional Medicare.

The only surprise is that it’s not higher among all diagnostic risk codes.

More docs need to review the “Success Codes” series on my blog.



The Opportunities and Challenges of offering Hospice as a carve-in

For MAOs, it’s much more beneficial as a carve-out.



Anthem is doing very well with Medicare Advantage

Very well.



Business groups also shifting risk to Medicare Advantage to their retirees

I’m surprised it took them this long to figure it out.




“The point of Medicare Advantage is not to make money—it’s to practice freely with joy.  Don’t let others’ pursuit of profit blind you to the tremendous opportunity the program offers clinicians. After Medicare Advantage, the only option left is cash-pay.”