#spoileralert

This argument (which I've read and seen supported multiple times) can only be made by those who understand ZERO about Risk Adjustment / ICD10/CMS documentation guidelines! #Spoileralert.... the documentation requirements for solid risk adjustment documentation are significantly higher and more specific than any traditional Medicare program asks for. THIS is why there is such a wide gap between the two. The system is too complex and complicated for any general practice provider (or even any specialist) to have the time to learn it, understand it nor feel it's worth their while to document specifically and with care unless they are somehow slightly incentivized to do so. MA advantage plans are paid higher for the same member profile bc without a provider working with a MA plan as a contracted member there is ZERO reason for them to take the time to learn and understand all of the coding nuances and rules for every diagnosis presented. The result??? Documentation and code assignment is generic and not specific, which results in a lower reimbursement for care for each complex patient. Why would any provider take the time to document and re-assess each ICD 10 diagnosis specifically if it didn't somehow benefit them or their patients??? This is where the system is currently inherently flawed. Specific and accurate documentation and coding diagnoses is a patient safety issue in my mind. Specific and accurate diagnoses and documentation that aligns with CMS ICD10 coding guidelines is best practice. it's just a shame that the result right now is to compare apples to oranges. They aren't the same. Period.