ArticleMedical care2026
Differences in the Measurement of Comorbidities Based on ICD-10-CM Coding Definitions Using Medicare Advantage Encounter Data and Fee-For-Service Claims.
Article in Medical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Advancing the measurement of favorable selection in Medicare Advantage: evidence from encounter data.Health affairs scholar · 2026Article
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Authors and funding
11 authors.
Funding
Abstract
backgroundMedicare Advantage (MA) encounter data became available for research in 2019; data quality concerns remain.
objectivesWe evaluated the consistency of ICD-10-CM comorbidity coding between MA and Fee-For-Service (FFS) data.
methodsWe used round 7 (2017) of the National Health and Aging Trends Study (NHATS) linked to Medicare enrollment, MA encounter, and FFS claims (2016-2017). We included participants continuously enrolled in MA or FFS for 1 year before round 7. Comorbidities were identified using ICD-10-CM codes from the Gagne combined comorbidity index. Demographic, socioeconomic, and clinical covariates from NHATS for FFS beneficiaries were standardized to resemble those for MA beneficiaries. We estimated crude and standardized comorbidity prevalence differences (PDs) between MA and FFS beneficiaries.
resultsAmong 5158 beneficiaries (MA: 40%, FFS: 60%), MA beneficiaries were more likely to be Black, Hispanic, and socioeconomically disadvantaged. After standardization, comorbidity prevalence was similar between groups. Peripheral vascular disorder (PD=7.2%, 95% CI: 3.8%-10.6%) and renal failure (PD=3.7%, 95% CI: 0.9%-6.5%) were more common in MA beneficiaries; fluid/electrolyte disorders (PD=-3.2%, 95% CI: -5.5 to -1.0%) and deficiency anemias (PD=-5.0%, 95% CI: -7.6 to -2.3%) were more common in FFS beneficiaries. Other PDs were less than 3 percentage points.
conclusionsDiscrepancies in comorbidity prevalence may reflect true differences or coding variations influenced by provider incentives, documentation standards, or diagnostic priorities. Comorbidity prevalence was largely consistent between MA encounters and FFS claims, supporting the reliability of MA encounter data for aging research. Additional validation studies should address remaining discrepancies.
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