As a result of insurers “upcoding” patient diagnoses, the Centers for Medicare and Medicaid Services (CMS) overpaid Medicare Advantage (MA) by $50 billion (or 13 percent) in 2024, according to the ...
Vivian Ho ([email protected]), Rice University and Baylor College of Medicine, Houston, Texas. Sasathorn Tapaneeyakul, Rice University. Heidi Voelker Russell, University of Texas, Houston, Texas.
In the complicated world of hospital billing, there’s a fine line between maximizing reimbursement and gaming the system. A new study shows a troubling trend as hospitals increasingly code for “sicker ...
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