Overview
- BCBSA published the analysis on Sept. 24 that ties roughly $942 million in added costs across its plans to a rise in coded inpatient complexity between early 2023 and late 2025.
- The study finds more than 55,000 excess complex inpatient cases that generated about $653 million in reimbursements and says complexity rose from roughly 37% to 40% of admissions in the period examined.
- Researchers say automated chart scanners and passive or ambient scribes are surfacing lab‑detectable secondary conditions—such as acidosis, low sodium and posthemorrhagic anemia—that can be added to claims without matching increases in treatments like transfusions or ICU use.
- Hospital leaders counter that payers have scaled automated claim review and denials, leaving providers behind on revenue‑cycle automation and raising operational and administrative strain for health systems.
- BCBSA plans more research, including outpatient analysis, while the industry weighs auditing, policy changes and how insurers and employers may respond to higher billed complexity that could affect premiums and payments.