AAOS News: Advocacy Win: CMS Cracks Down on Upcoding in CY 2027 MA and Part D Advanced Notice
As steadfast advocates for improving Medicare beneficiaries’ quality of care, AAOS celebrates new coding proposals from CMS as a part of the CY 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and MA and Part D Payment Policies. Proposals include excluding diagnosis information from unlinked Chart Review Records — which is diagnosis information not associated with a specific beneficiary encounter — from risk score calculation starting in CY 2027. These updates aim to reduce administrative burden, create competition equally between MA plans based on value to patients, and ensure payments accurately reflect beneficiary health. This update marks an important step in MA reform and aligns with the AAOS-endorsed NO UPCODE Act introduced by Senators Bill Cassidy (R-LA) and Jeff Merkley (D-OR) last year.