CMS Unfairly Links Medicare Cuts to Upcoding, New York Hospitals Say

New York hospitals said CMS’ proposal to cut reimbursements nationwide to reflect alleged upcoding of services is unfair and would cause $250 million a year in losses in New York alone, according to a report by Crain’s New York Business.

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Dan Sisto, president of the Hospital Association of New York State, said the rising severity of billing codes for hospitals across the country that CMS identified was caused by changes in patient mix and was not by an attempt to get more money.

“We have had such an emphasis on moving patients out of hospitals,” Mr. Sisto said. “If you take out the easy-to-care-for patients and increase those who are most severely ill, the math tells you there will be a natural increase in severity in acute care.”

Mr. Sisto said members of Congress from New York are sympathetic about the issue, given upcoming reductions in hospital funding under health reform. “They understood that we’d just taken a huge hit going forward and that we already lose money on Medicare,” he said, referring to recent meetings with the federal lawmakers.

Read Crain’s New York Business’ report on hospital billing practices.

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