NICU Cost Containment in DRG Environments: What ProgenyHealth Sees that Health Plans May Be Missing

Posted by ProgenyHealth on July 22, 2019 at 10:28 AM

Medical costs for newborns are some of the fastest growing in healthcare - mostly driven by infants requiring NICU services. Such cases represent a small percentage of the newborn population (approx. 15%) but consume a large percent of the total cost of care for this group (>40%). The increasing costs are partially attributed to cases where claims are submitted for the newborn’s NICU admission with a single revenue code level that reflects a higher resource use intensity than is documented in the records for the duration of care, resulting in higher than expected costs to the health plan.

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