News: Hospitalists more likely to bill high-severity encounters compared to non-hospitalists, study shows

CDI Strategies - Volume 16, Issue 19

Hospitalists coded a significantly higher proportion of Medicare beneficiaries as high severity compared to non-hospitalists, according to a study published in the Journal of the American Medical Association (JAMA) Health Forum. This gap has widened over time from the study’s earliest samples from 2009 to the latest in 2018, JustCoding reported.

The study looked at more than four million Medicare fee-for-service Part A and Part B medical claims between the years of 2009 and 2018 and compared the high-severity billing between hospitalists versus non-hospitalists across initial, subsequent, and discharge encounters. Hospitalists were defined as physicians with primary specialties in internal medicine, general practice, family practice, or hospital practice where 90% of their evaluation and management claims within a given year were for inpatient services. 

Researchers found that “high-severity billing increased over time for hospital encounters at higher rates for hospitalists than non-hospitalists,” and these differences were not explained by differences in patient complexity. The findings suggest that hospital spending in the Medicare program may be in part driven by upcoding of inpatient encounters. Additional research is needed to determine drivers of high-intensity billing and to develop strategies for mitigating potential upcoding.

Editor’s note: This story originally appeared in JustCoding. To read more about the topic of upcoding, click here.

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