Research reveals upcoding in hospital stays leads to billions in extra payments

Medical Xpress December 3, 2024
RAND Corporation

In five states over nearly a decade, hospitals have increased how frequently they document patients as needing the highest intensity care, which has led to hospitals receiving billions in extra payments from health plans and government programs, according to a new RAND study.

Among thousands of cases involving hospital stays for 239 conditions, researchers examined how often hospitals upcoded patients to the sickest end of the care spectrum, where hospitals charge payers at the highest rate.

The study found that from 2011 to 2019, the number of patient discharges documented as needing the highest intensity care increased by 41%. Adjusting for changes in patient demographics, pre-existing comorbidities, length-of-stay and hospital characteristics, researchers estimated that the increase would have been 13%...

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