No UPCODE Act aims to improve Medicare Advantage risk adjustment by excluding certain diagnoses and using 2 years of diagnostic data.
The No UPCODE Act, or No Unreasonable Payments, Coding, Or Diagnoses for the Elderly Act, seeks to enhance risk adjustment under Medicare Advantage. Starting in 2026, the Act mandates the exclusion of diagnoses collected from chart reviews or health risk assessments when establishing payment adjustment factors. It also requires the Secretary of Health and Human Services to identify and verify such diagnoses. Additionally, the Act stipulates the use of two years of diagnostic data for risk adjustment, when available.
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- Overview
- Core Provisions
- Implementation
- Impact
- Legal Framework
- Critical Issues
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