Too Sick to be True? Evaluating Potentially Problematic Diagnosis Coding Practices in Medicare's Patient‐Driven Payment Model
PDPM was associated with increased coding intensity across multiple measures-and more so in for-profit SNFs-highlighting the need to further evaluate whether SNFs are accurately documenting or falsely inflating clinical complexity. Sustaining Medicare's payment accuracy will require continued monitoring of diagnosis coding behavior and its alignment with actual clinical complexity.
Authors
- Tracy M. Mroz (ORCID: https://orcid.org/0000-0003-1889-4252)
- Rachel A. Prusynski (ORCID: https://orcid.org/0000-0002-9376-2041)
- Harsha Amaravadi (ORCID: https://orcid.org/0000-0001-6486-9504)
- Natalie E. Leland (ORCID: https://orcid.org/0000-0002-0329-3772)
- Paul A Fishman
Institutions
- University of Pittsburgh (US)
- University of Washington (US)
Publication Details
- Journal
- Health Services Research
- Published
- 2026-02-09
- DOI
- https://doi.org/10.1111/1475-6773.70084
- Primary Topic
- Medical Coding and Health Information
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- University of Washington
- National Institutes of Health
- National Institute of Child Health and Human Development
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development