Massachusetts hospitals increasingly coding at the highest severity level

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Massachusetts hospitals are increasingly billing inpatient stays at the highest severity level — and at the most expensive one — according to a report from the Massachusetts Health Policy Commission. 

The commission found that in 2020, excluding COVID-19 diagnoses, 9.1 percent of inpatient admissions were coded at severity level 4, and 31.5 percent were coded at severity level 3. In comparison, in 2013, 4.4 percent of inpatient admissions were coded at severity level 4, and 23.7 percent were coded at severity level 3. Level 4 denotes the highest severity. 

A similar trend was also found in Medicare claims in a report released in February. The HHS' Office of the Inspector General found that Medicare beneficiary hospitalizations billed at the highest severity level increased nearly 20 percent between fiscal years 2014 and 2019. During the same study period, the number of stays billed at the other severity levels decreased. 

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