Table 4.

Financial impact of undocumented Chronic Kidney Disease. Estimated unrealized reimbursement opportunity for undocumented CKD for Medicare Advantage alone, for the 3 institutions combined in calendar year 2021

Annual Reimbursement per Beneficiary	Total Individuals with CKD documented by Lab onlya	Estimated number of Beneficiariesb	Annual Reimbursement per Beneficiary (2021)c	Unrealized Risk Adjustment Reimbursementd
Medicare Advantage CKD Stage 3	29,167	2866	$ 581	$1,665,146
Medicare Advantage CKD Stage 4	3231	312	$1,987	$619,944
ACA Marketplace CKD Stage 4	3231	68	$8,377	$569,636

ACA Affordable Care Act, CKD chronic kidney disease

^aFrom Table 3. ^bEstimated number of Medicare Advantage beneficiaries on the basis of % Medicare beneficiaries by state in 2021 (https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D; accessed February 11, 2024), pro-rated to % of Medicare beneficiaries enrolled in Medicare Advantage in 2021 (https://www.kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries/#:~:text=In%202021%2C%20Medicare%20Advantage%20covered,%25%20of%20all%20eligible%20beneficiaries; accessed February 11, 2024); estimated Affordable Care Act (ACA) Marketplace beneficiaries estimated on the basis of % of population enrolled (https://www.kff.org/affordable-care-act/state-indicator/total-marketplace-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D; accessed February 13, 2024). ^cAnnual Medicare Advantage Reimbursement per Beneficiary in 2021 based on Medicare Advantage payment policies (https://www.cms.gov/files/document/2021-announcement.pdf; https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-2021-Benefit-Year-Final-HHS-Risk-Adjustment-Model-Coefficients.pdf, both accessed February 11, 2024); Affordable Care Act (ACA) Marketplace Reimbursement per Beneficiary in 2021 based on Final Risk Adjustment Model Coefficients (https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-2021-Benefit-Year-Final-HHS-Risk-Adjustment-Model-Coefficients.pdf; accessed February 13, 2024). ^dMultiplicand of Estimated number of Beneficiaries and Annual Reimbursement per Beneficiary (2021). See Supplement for further details