"Aetna determined the patient was 'low severity,' even though the patient was intubated in an ICU, had acute renal failure, and was administered broad spectrum IV antibiotics for multifocal pneumonia."
"Jefferson argued that this effectively 'downcodes' legitimate inpatient care, therefore reducing hospital revenue and creating additional administrative burdens for providers to deal with as they appeal the lower payments."
Jefferson Health and Lehigh Valley Physician Hospital Organization are suing Aetna over its new payment policy for Medicare Advantage beneficiaries. Aetna's policy allows for lower payments for certain inpatient stays if deemed 'low severity,' despite physician admissions. The lawsuit cites a specific case of a 72-year-old patient with serious health issues who was classified as 'low severity' by Aetna after two nights in the hospital. Jefferson claims this practice reduces hospital revenue and imposes additional administrative burdens on providers.
Read at MedCity News
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