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A new study has found that the U.S. health system has much higher costs for billing due in part to complexity of its medical coding. The researchers used a microlevel analysis of billing and insurance related (BIR) costs in five nations with similar economies and found the U.S. and Australia had much higher levels of costs, due to coding complexity.

The BIR costs ranged from a low of $6 for a surgical inpatient bill in Canada to $215 in the U.S. “Coding activities were the primary driver of high BIR costs in both Australia and the U.S.,” the study says. “Hospitals in Canada, Germany, Singapore, and the Netherlands incurred much lower burdens for both coding activities and overall BIR costs, which suggests that U.S. policymakers and industry leaders should explore simplifying and standardizing payment procedures.”

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