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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2023
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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. |
format | Online Article Text |
id | pubmed-10462079 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
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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