학술논문

Sepsis-2.5: Resolving Conflicts Between Payers and Providers
Document Type
Academic Journal
Source
Critical Care Explorations. Sep 01, 2023 5(9):e0970-e0970
Subject
Language
English
ISSN
2639-8028
Abstract
Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2, payer use of Sepsis-3 to validate clinical diagnoses may result in denial of payment or requests to recoup previously paid funds from healthcare providers. The Sepsis-2.5 project was a cooperative effort between a hospital system and a private payer to develop a community-based, literature-supported consensus definition for sepsis characterized by the presence of clinical illness, a source of infection, and evidence of organ dysfunction. This new definition (“Sepsis-2.5”) has been instrumental in resolving provider-payer conflicts in defining clinical sepsis and reimbursing care.