{"id":1433628,"date":"2026-02-09T04:30:00","date_gmt":"2026-02-09T09:30:00","guid":{"rendered":"https:\/\/www.statnews.com\/?p=1433628"},"modified":"2026-02-06T18:06:38","modified_gmt":"2026-02-06T23:06:38","slug":"medicare-advantage-new-cms-risk-scores-target-insurer-upcoding","status":"publish","type":"post","link":"https:\/\/www.statnews.com\/2026\/02\/09\/medicare-advantage-new-cms-risk-scores-target-insurer-upcoding\/","title":{"rendered":"Federal government turns to fresher data to rein in Medicare Advantage upcoding"},"content":{"rendered":"

The health insurance industry was caught off guard by the federal government\u2019s recent proposal to keep next year\u2019s payments to Medicare Advantage plans mostly flat<\/a>, and to change a controversial coding practice<\/a>. But another equally significant change has flown under the radar \u2014 and is a major reason why some insurers may face big hits to revenue.<\/p>\n\n\n\n

The Centers for Medicare and Medicaid Services is proposing to use newer data when paying Medicare Advantage plans in 2027. And that data implies people with chronic health problems are not seeing their doctors nearly as much as their health profiles suggest they should.<\/p>\n\n\n