Hospital upcoding leads to billions in extra payments: Study

Becker's Healthcare December 5, 2024
Alan Condon

A Rand study published Dec. 3 reveals that from 2011 to 2019, hospitals in five states significantly increased the frequency of documenting patients as requiring the highest intensity care, resulting in billions of dollars in additional payments from CMS and commercial payers.

The study, published in Health Affairs, analyzed thousands of hospital stays for 239 conditions in Florida, Kentucky, New York, Washington and Wisconsin, finding a 41% increase in high-intensity coding over the period. Adjusted for patient demographics and other factors, researchers estimate that coding changes alone accounted for a 13% increase, contributing to $14.6 billion in payments in 2019.

Six things to know:

1. Researchers found $14.6 billion in extra payments in 2019 due to upcoding, including $5.8...

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