BIG: Hospitals Raise Severity Levels for Medicare Patients

BIG: Hospitals Raise Severity Levels for Medicare Patients

Hospital stays have become more dear to the Medicare program, and it’s a trend that began even before the COVID-19 pandemic. A new report from the Office of the Inspector General of the Department of Health and Human Services has uncovered a possible reason: many hospitals are increasingly charging for inpatient stays at the highest severity level, which is also the more expensive.

In an analysis of Medicare Part A claims from 2014 to 2019, the OIG found that the most expensive stays – those involving a serious medical complication – increased by about 20%, with the price differential between the diagnostic group of the highest and lowest Medicare severity for a disease. like pneumonia coming in at $ 4,175 versus $ 8,505. It is more that double over the 5-year period.

In the end, that represented almost half of all Medicare spending for hospital stays. The number of stays billed at each of the other severity levels has decreased.

At the same time, the average length of stay decreased for stays at the highest severity level, while the average length of all stays remained largely the same.

The problem, according to the OIG, is that stays at the highest severity level are vulnerable to improper billing practices such as upgrading, practicing billing at a higher level than warranted.

More precisely, almost a third of these stays lasted a particularly short period of time and more more than half of stays billed at the highest level of severity only included a single diagnosis qualifying them …


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