2010年至2018年间急诊室检查医疗保险退款的趋势
Summer Ghaith1, Zachary Ginsberg2, Jordan Pollock2
1Emergency Medicine, Mayo Clinic, Phoenix, USA.
Cureus
|August 19, 2024
概括
医疗保险对急诊室 (ED) 服务的报销从2010年到2018年大幅下降,尽管医生费用上升. 这一趋势可能会对医疗保健结果产生负面影响,因为医疗保健提供者面临财务压力.
科学领域:
- 卫生经济学 卫生经济学
- 医疗政策 医疗政策
- 紧急医疗 紧急医疗
背景情况:
- 医疗保险人口的增长增加了医疗保健提供者的财务压力.
- 了解报销趋势对于提供商的可持续性至关重要.
研究的目的:
- 从2010年到2018年分析医疗保险对急诊室 (ED) 检查 (CPT代码99281-99285) 的报销趋势.
- 确定与考试水平相对的报销变化.
主要方法:
- 从医疗保险医生/供应商程序摘要 (2010,2018) 中提取的CPT代码数据.
- 分析了紧急医生的提交,医疗保险支付和拒绝.
主要成果:
- 提交ED检查的总数增加了,但医疗保险的支付比例从20.5% (2010) 降至11.9% (2018).
- 2018年,拒绝率在I级考试中最高,在V级考试中最低.
- 五级考试的使用率增加了22.3%,而其他考试的使用率则下降了.
结论:
- 紧急医生收取更多费用,但医疗保险支付的比例较小,减少了大多数ED检查水平的每次提交费用.
- 降低医疗保险报销趋势可能会造成财务负担,可能会影响医疗保健结果.
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