ED Coding Leaves Payers and Providers at Odds

Recent increases in high-intensity emergency department (ED) billing in the US have put payers and providers at odds. A recently published study in Health Affairs investigates the underlying causes of this growth, looking at data from the Nationwide Emergency Department Sample. Almost half the increases come down to administrative changes and higher utilization by older adults. Another reason for the recent increase in high-intensity billing, the authors argue, comes down to coding changes.

According to Jacqueline LaPointe, “Upcoding, a correction for historical downcoding, and an increased focus on revenue cycle management after years of rudimentary coding and management practices, especially for EDs run by independent hospitals, may have contributed to higher-level ED visits despite fewer patients being admitted to the hospital.”

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(Source: RevCycleIntelligence, December 8^th, 2022)