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Related Experiment Videos

Variation in coding influence across the USA. Risk and reward in reimbursement optimization.

Daniel P Lorence1, Michael Richards

  • 1Department of Health Policy and Administration, Pennsylvania State University, State College, Pennsylvania, USA.

Journal of Management in Medicine
|January 22, 2003
PubMed
Summary
This summary is machine-generated.

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Despite stricter anti-fraud policies and penalties in US healthcare, health information managers still face pressure to manipulate patient data coding. This study reveals that fraudulent billing practices persist due to internal and external influences on coding classification.

Area of Science:

  • Health Services Research
  • Healthcare Fraud
  • Medical Coding

Background:

  • Recent US healthcare anti-fraud policies have increased penalties for overcharging.
  • Speculation exists regarding the effectiveness of these policies in curbing fraudulent billing and service misclassification.

Purpose of the Study:

  • To measure the extent to which health information managers are influenced by superiors to manipulate patient data coding and classification.
  • To examine the variation in these influences across different demographic, practice setting, and market characteristics.

Main Methods:

  • A nationwide survey of health information managers was conducted.
  • Analysis examined influences exerted from within and external to healthcare service delivery settings.

Related Experiment Videos

Main Results:

  • Health information managers reported ongoing pressure to manipulate coding and classification of patient data.
  • Such pressures originate from both within and external to provider settings.
  • Significant variations in these influences were observed across different practice settings and market types.

Conclusions:

  • Fraudulent billing and service misclassification remain pervasive in the US healthcare system, despite recent legislative efforts.
  • Understanding the sources of influence on coding practices is crucial for improving reimbursement programs and ensuring evidence-based healthcare.