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OIG: Hospitals are upcoding severity levels for Medicare patients

Hospitals likely upcoding severity levels for Medicare patients, OIG says

Dive Brief: A new report by the HHS Office of Inspector General indicated that inpatient hospital stays have become more expensive to the Medicare program, even before the COVID-19 pandemic began to severely disrupt the U.S. healthcare system a year ago. HHS OIG analyzed Medicare Part A claims for inpatient stays from fiscal year 2014 through 2019. The analysis found that hospitals are increasingly billing for inpatient stays at the highest severity level, which is the most expensive one. The priciest stays those accompanied by a significant medical complication rose nearly 20% over the six years that were examined. The price gap between the highest and lowest Medicare Severity Diagnosis Related Group can be more than double for treating the same illness such as pneumonia ($4,175 versus $8,505).

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