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.

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Nichole Morford

Nichole Morford
Managing Editor

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