Watchdogs are gunning for hospital coding

Surgical nurses look at a computer in a hospital.
Hospital nurses review electronic medical records. Photo: Jonathan Wiggs/The Boston Globe via Getty Images

The Centers for Medicare & Medicaid Services and HHS' Office of Inspector General will conduct a "two-part study," expected to completed by 2020, that will scrutinize how hospitals overcharge Medicare — a practice known as upcoding.

Why it matters: Medicare paid hospitals $114 billion for inpatient stays in 2016, or about 17% of all Medicare payments. OIG has long criticized inpatient coding, a main artery for hospital finances, and this move foreshadows potentially bigger clawbacks on bad actors.

Mandatory health care demos are back

 U.S. Secretary of Health and Human Services Alex Azar speaks on prescription drugs
U.S. Secretary of Health and Human Services Alex Azar. Photo: Alex Wong/Getty Images

Under the leadership of then-Secretary Tom Price, the Department of Health and Human Services substantially rolled back mandatory pilot programs. But Price isn’t the boss any more, and mandatory demonstration programs are back.

How it works: HHS is on a perpetual quest to change the way Medicare pays for care. One leading part of that effort involves bundling together the many individual payments Medicare would normally make for a one procedure.

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