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Coding errors encountered in DRG study.
Journal (American Medical Record Association)
|June 9, 1986
Summary
This study examined coding practices for Diagnosis-Related Groups (DRGs) to prevent payment errors. It found specific DRGs were vulnerable to incorrect coding, necessitating targeted reviews.
Area of Science:
- Health Services Research
- Medical Coding Auditing
Background:
- The Office of the Inspector General (OIG) initiated a review in 1984-1985.
- Technical assistance was provided by the American Medical Record Association (AMRA).
Purpose of the Study:
- To assess the vulnerability of Diagnosis-Related Groups (DRGs) to incorrect or manipulative coding.
- To identify potential for erroneous Medicare payments due to coding issues.
Main Methods:
- Initial analysis of all DRGs to identify potential payment errors.
- Focused review of three specific DRGs (14, 88, and 82) based on initial analysis.
Main Results:
- The review identified specific DRGs susceptible to coding vulnerabilities.
- The analysis aimed to pinpoint DRGs with a high potential for incorrect reimbursement.
Conclusions:
- Certain DRGs pose a risk for inaccurate coding and potential financial overpayments.
- Targeted review of DRGs 14, 88, and 82 was conducted to address identified vulnerabilities.