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- March 2019
- Article
Evidence of Upcoding in Pay-for-Performance Programs
By: Hamsa Bastani, Joel Goh and Mohsen Bayati
Recent Medicare legislation seeks to improve patient care quality by financially penalizing providers for hospital-acquired infections (HAIs). However, Medicare cannot directly monitor HAI rates and instead relies on providers accurately self-reporting HAIs in claims...
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Keywords:
Medical Coding;
Health Policy;
Healthcare-acquired Conditions;
Medicare;
Health Care and Treatment;
Policy;
Performance Improvement;
Quality;
Measurement and Metrics;
Government Legislation
Bastani, Hamsa, Joel Goh, and Mohsen Bayati. "Evidence of Upcoding in Pay-for-Performance Programs." Management Science 65, no. 3 (March 2019): 1042–1060. (2015 INFORMS Health Applications Society best student (H. Bastani) paper award.)