Healthcare Finance News November 17, 2025
“Level of severity review,” which determines reimbursement, has drawn the ire of the American Hospital Association.
Insurer Aetna is pulling back on a downcoding policy for inpatient Medicare Advantage claims after at least one prominent hospital group criticized the original policy.
In a notice posted to its website, Aetna said that level of severity review will only apply to urgent or emergent inpatient stays of at least one midnight, but less than five midnights. Level of severity review is the process of classifying a patient’s condition to determine the medical necessity of treatment, appropriate care settings and, ultimately, the level of reimbursement.
Stays of five midnights or greater will not be subject to level of severity review and...
Today's Sponsors
Today's Sponsor