What Blue Cross Blue Shield data reveals about emergency room upcoding

A study of Blue Cross Blue Shield claims data from five states found price increases were a bigger contributor to rising emergency room costs than upcoding. 

The study, published Aug. 7 in Health Affairs, examined Blue Cross Blue Shield claims data from 2012 to 2019 in Colorado, Massachusetts, Texas, North Carolina and Ohio. 

According to the study, rising prices contributed to at least 50 percent of spending growth in four of the five states studied. 

Upcoding — submitting diagnosis codes to payers to make patients appear sicker than they are to receive higher reimbursements — contributed to rising emergency room prices as well, the researchers found. 

Upcoding ranged from comprising 7.9 percent of spending increases in Ohio to 48.9 percent of spending increases in Massachusetts. 

The study was written by researchers at Rice University, Baylor University and the University of Texas, all based in Houston. Read the full study here. 

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