Wiki Impact of Comorbidities on Outpatient Reimbursement

[Bowerp]

Can anyone tell me if Comorbidities have an impact on reimbursement in the Outpatient/Ambulatory Surgery Arena?

 

[thomas7331]

For all of the payers that I've ever worked with, comorbidities do not impact the reimbursement rates of individual outpatient facility claims. However, many facilities now participate in risk adjustment and shared savings programs with payers, so even if the individual claim-level payment is not affected, it can have an impact on the overall revenue of both the payers and the facilities if comorbidities are not reported. Because of this, I think it has become a standard expectation that comorbidities that are documented as existing at the time of the encounter are routinely coded even for outpatient claims.