Inpatient encounters for Medicare patients 65 years and older are associated with higher coding intensity compared with commercially insured, Medicaid, or self-pay hospitalizations for those same ...
Under the Inpatient Prospective Payment System, documentation is the payment. Every under-documented CC/MCC lowers the DRG relative weight, suppresses case mix index (CMI), and understates the true ...
Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code ...
Incorrect diagnosis codes from providers led to a $14 million windfall for some Medicare Advantage plans, a federal watchdog found. The Department of Health and Human Services’ Office of Inspector ...
Device makers and physicians alike were less than enthused about several features of the draft Medicare inpatient rule for fiscal year 2025, but thanks in part to support from the device industry, the ...
Hospitals decide how much to bill Medicare for your care based on your diagnostic-related group (DRG). They then charge Medicare based on your DRG tier instead of separately for each of your medical ...
The clash between payers and providers over AI-driven coding is intensifying, with insurers arguing that documentation tools are inflating reimbursement without corresponding care. AI is quickly ...
As we reported in our Managed Care Newsletter in April 2020, the CARES Act passed by Congress last year provides for a 20% increase to the DRG weights in the Medicare Inpatient Prospective Payment ...
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