Increasing Financial Performance of PHM Programs Through Appropriate Critical Care Billing

Children meeting Centers for Medicare and Medicaid Services (CMS) criteria for critical care billing are often cared for by pediatric hospital medicine teams outside the intensive care unit (ICU). Current CMS guidance allows for billing of critical care codes outside of an ICU. These codes have substantially higher relative value units (RVU) attached to them and reimburse at higher rates than the usual evaluation and management codes. Several efforts to optimize use of critical care billing has been described in emergency medicine literature, though few efforts have been described with hospitalists.