Center for Advancing Health Policy through Research
MediCode Tool
The MediCode tool provides insights into how MA plans may be inflating risk scores and receiving billions in additional federal payments.
MediCode Tool
The MediCode tool provides insights into how MA plans may be inflating risk scores and receiving billions in additional federal payments.
About the Tool
The MediCode tool provides unprecedented insight into how Medicare Advantage (MA) plans may be inflating risk scores and receiving billions in additional federal payments by quantifying coding intensity across MA plans and parent organizations.
Motivation
MA plans have an incentive to potentially make enrollees appear sicker on paper than they are in reality, driving up risk scores and federal reimbursement. MediCode equips policymakers, regulators, and researchers with transparent, standardized metrics to evaluate variation in diagnostic coding, pinpoint the drivers of excessive payments, and inform evidence-based policy responses.
Tool Features
Transparent, reproducible metrics comparing coding intensity across contracts and parent companies, as well as state-level differences in coding intensity
Open-source documentation to support academic and policy research
A detailed breakdown of how policy levers (such as coding caps or audit reforms) would impact payments
Actionable insights to inform potential MA payment oversight and legislative reforms
What Does the Tool Find?
As Congress looks for ways to reduce Medicare spending without impacting beneficiaries, the tool reveals how coding practices in Medicare Advantage plans could be driving $30 billion in excess payments in 2025 alone.