An interactive tool from Brown University’s CAHPR to explore coding intensity and potential upcoding in Medicare Advantage across plans, regions, and time.
Center for Advancing Health Policy through Research
MediCode Tool
Medicare Advantage Coding Intensity & Upcoding Tool
MediCode Tool
Medicare Advantage Coding Intensity & Upcoding Tool
About MediCode: Exploring Coding Intensity in Medicare Advantage
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 is an interactive tool developed by the Center for Advancing Health Policy through Research (CAHPR) at Brown University that 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. The tool enables users to explore how diagnostic coding varies across plans, regions, and over time—an issue with important implications for Medicare spending and payment accuracy.
Tool Features
Transparent, reproducible metrics comparing coding intensity across contracts and parent companies, as well as state-level differences in coding intensity.
A detailed breakdown of how policy levers (such as coding caps or audit reforms) would impact payments.
Open-source documentation to support academic and policy research.
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.