Filed Under:Markets, Employee Benefits

Actuary: PPACA drags insurers into diagnosis code war

(LHP graphic)
(LHP graphic)

Health insurers have traditionally been suspicious of doctors, hospitals and other care providers that have taken an aggressive approach to describing the severity of patients' diagnoses. 

Now, however, the Patient Protection and Affordable Care Act of 2010 (PPACA) may be giving health insurers a financial incentive to persuade providers to code diagnoses as aggressively as the facts permit.

In the PPACA system, Berger said, submitting accurate and complete diagnosis information to HHS could be as important to financial success as pricing coverage accurately and managing claims costs.

The shift in carrier thinking will be similar to what the carriers that run Medicare Advantage plans went through in 2004, Berger said.

Featured Video

Most Recent Videos

Prospects not listening to voice mail? Arrange a phone date


Redesigning your phone life is more important than finding the “best words” for a voice mail in today’s culture.

Behind the scenes with Vicki Gunvalson [VIDEO]


In this exclusive interview, Vicki Gunvalson shares how she built a $15 million a year annuity business by planning for...

Regulator: Market may need to reinvent LTCI


Cioppa says Maine's governor wants to spur the creation of better products.

Dementia: It's more than Alzheimer's


An association calls for policymakers to remember lesser-known neurodegenerative conditions.

Related resources

More Resources


Power your business with up-to-the-minute insurance news, analysis, and best practices from LifeHealthPro Daily eNewsletter – FREE.

Power your business with LifeHealthPro Daily eNewsletter – FREE.

Enter a valid email address.
Nichole Morford

Nichole Morford
Managing Editor

Thank you for subscribing to LifeHealthPro Daily!

Check Out More eNewsletters Now! Close

Advertisement. Closing in 15 seconds.