Massachusetts hospitals coding at higher acuity to increase pay, watchdog says

Massachusetts hospitals are coding patient diagnoses at higher severity levels to receive more reimbursement, preliminary data obtained by CommonWealth suggests.

The preliminary data, issued Sept. 11, comes from researchers at the Massachusetts Health Policy Commission, a state watchdog agency that examined the practice of hospitals mining patient medical history through their EHR systems to boost the complexity of diagnosis billing codes and maximize payment.

Researchers found that Medicaid hospital payment for a Massachusetts patient with chronic obstructive pulmonary disease in 2017 was $4,584 at the lowest severity level and $16,500 at the highest severity level. They also found that the percent of COPD discharges (all payers) at the highest severity level climbed from 3 percent in 2013 to 12 percent in 2017. During the same period, the percent of COPD discharges (all payers) at the lowest severity level decreased from 14 percent to 7 percent.

The commission estimated that the state saw $280 million more in inpatient Medicare costs and as much as $300 million more in inpatient commercial costs in 2017 because of increases in inpatient acuity between 2013 and 2017.

"Even if payers are able to offset some of the increased spending from coding intensity, it requires additional time and resources from payers and auditors," researchers added.

David Seltz, executive director of the commission, said at a recent commission board meeting that more research is needed to document and find potential solutions to the problem of the coding and the cost associated with it, according to CommonWealth.

The commission expects to release its full analysis in early 2020.

 

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