Medical bill The OIG recommends more-targeted billing reviews by the CMS to identify instances of upcoding, focusing in particular on highest-severity claims. (Photo: Shutterstock)

Here’s another important reminder for consumers to double-check their EOB and employers to keep a close eye on their claims data: A report out from the HHS Office of Inspector General examining Medicare reimbursements found that hospitals billing at the highest-severity level (and thus higher billing) increased by 20% between 2014 and 2019.

Perhaps patients are suffering from more-severe health events? More likely, the OIG warned, hospitals are increasingly upcoding to increase their reimbursements. Specifically, the report noted that a third of stays lasted a particularly short time and billed for only one qualifying diagnosis, suggesting that the patient was less sick than the billing suggested.

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Emily Payne

Emily Payne is the current deputy editor for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.

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