Jefferson Health filed a lawsuit against insurer Aetna this week over a new “downcoding” policy regarding inpatient admissions for Medicare Advantage beneficiaries.
The health system claims that the policy violates federal law and reduces payments for hospital stays for Medicare Advantage patients that Aetna decides aren’t sick enough to qualify for full payment. Jefferson Health also claims that Aetna failed to comply with the terms of their agreement.
Jefferson is asking a judge to stop Aetna from implementing the policy…