LAUSR

Key Points Question Do insurance policies that retrospectively reduce payments for nonemergent pediatric emergency department (ED) visits by using claims algorithms introduce potential racial and ethnic differences in reimbursement? Findings This cohort study of MarketScan Medicaid data included 8 471 386 ED visits and simulated the potential impact of 1 state Medicaid policy. Visits to the ED by Black (50%) and Hispanic (49%) children had a higher likelihood of being algorithmically identified as nonemergent and subject to professional reimbursement reductions compared with visits by White children (45%). Meaning This study found that bias contained in the output of claims algorithms that retrospectively identify nonemergent pediatric ED visits may introduce inequity in health care financing.