TOO SICK TO BE TRUE? EVALUATING PROBLEMATIC CODING PRACTICES IN MEDICARE’S PATIENT DRIVEN PAYMENT MODEL
2024
Evaluating Problematic Coding Practices in Medicare’s Patient Driven Payment Model
Sample size: 5430000
publication
Evidence: moderate
Author Information
Author(s): Amaravadi Harsha, Prusynski Rachel, Fishman Paul, Mroz Tracy
Primary Institution: University of Washington
Hypothesis
Upcoding may occur for common, chronic conditions associated with high reimbursement under PDPM.
Conclusion
The study found increased documentation for certain conditions, indicating potential upcoding in Medicare claims.
Supporting Evidence
- The study analyzed 5.43 million Medicare claims.
- Increased documentation was detected for complicated diabetes, severe anemia, and obesity.
Takeaway
The study looked at how doctors might be exaggerating patient conditions to get more money from Medicare, and they found that this is happening a lot.
Methodology
Analyzed Traditional Medicare claims from 2018-2021 using a difference-in-difference design.
Statistical Information
Confidence Interval
[95%CI: 31.55, 32.82], [95%CI: 52.33, 56.95], [95%CI: 82.00, 84.15]
Digital Object Identifier (DOI)
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