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Sepsis-2.5: Resolving Conflicts Between Payers and Providers

Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2, payer use of Sepsis-3 to validate clinical diagnoses may result in denial of payment or requests to recoup previously paid funds from h...

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Detalles Bibliográficos
Autores principales: Rodenberg, Howard, Glasser, Theodore, Bartfield, Alison, Katugaha, Shalika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10462079/
https://www.ncbi.nlm.nih.gov/pubmed/37644973
http://dx.doi.org/10.1097/CCE.0000000000000970
Descripción
Sumario:Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2, payer use of Sepsis-3 to validate clinical diagnoses may result in denial of payment or requests to recoup previously paid funds from healthcare providers. The Sepsis-2.5 project was a cooperative effort between a hospital system and a private payer to develop a community-based, literature-supported consensus definition for sepsis characterized by the presence of clinical illness, a source of infection, and evidence of organ dysfunction. This new definition (“Sepsis-2.5”) has been instrumental in resolving provider-payer conflicts in defining clinical sepsis and reimbursing care.