Viewpoint
Less Is More
The Impact of Definitions of Disease on Overdiagnosis
Kari A. O. Tikkinen, MD, PhD1,2,3,4; Alex L. E. Halme, BSc1; Gordon H. Guyatt, MD4,5; et alPaul Glasziou, MD, PhD6
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June 9, 2025
Coding and insurance reimbursements
Victor Bell, MD | Private
I wonder how much insurance reimbursements and coding increases the need to define more things as disease. You can't get paid for "normal variation".
CONFLICT OF INTEREST: None Reported
June 9, 2025
Pertinent to Medicare Advantage Funding Issues with Disease-based Adjustment
BRUCE QUINN, MD PHD | Consultant
This article is relevant to current debates about the funding, or over-funding, of Medicare Advantage plans, which are risk-adjusted based on disease diagnoses. The relevant ICD-10 system is an inventory of coded diseases, but rarely has much information on the definitions of disease that should be used. This leaves CMS, auditors and managed care plans with numerous potential debates over what definitions should be applied when creating or reviewing the ICD-10 assignments.
CONFLICT OF INTEREST: None Reported
