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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
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author Rodenberg, Howard
Glasser, Theodore
Bartfield, Alison
Katugaha, Shalika
author_facet Rodenberg, Howard
Glasser, Theodore
Bartfield, Alison
Katugaha, Shalika
author_sort Rodenberg, Howard
collection PubMed
description 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.
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spelling pubmed-104620792023-08-29 Sepsis-2.5: Resolving Conflicts Between Payers and Providers Rodenberg, Howard Glasser, Theodore Bartfield, Alison Katugaha, Shalika Crit Care Explor Commentary 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. Lippincott Williams & Wilkins 2023-08-25 /pmc/articles/PMC10462079/ /pubmed/37644973 http://dx.doi.org/10.1097/CCE.0000000000000970 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Commentary
Rodenberg, Howard
Glasser, Theodore
Bartfield, Alison
Katugaha, Shalika
Sepsis-2.5: Resolving Conflicts Between Payers and Providers
title Sepsis-2.5: Resolving Conflicts Between Payers and Providers
title_full Sepsis-2.5: Resolving Conflicts Between Payers and Providers
title_fullStr Sepsis-2.5: Resolving Conflicts Between Payers and Providers
title_full_unstemmed Sepsis-2.5: Resolving Conflicts Between Payers and Providers
title_short Sepsis-2.5: Resolving Conflicts Between Payers and Providers
title_sort sepsis-2.5: resolving conflicts between payers and providers
topic Commentary
url 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
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