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Physician code creep after the initiation of outpatient volume control program and implications for appropriate
Fu-Wen Liang1, Liang-Yi Wang2, Lin-Yi Liu3
1Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
Physician code creep, or changing coding for reimbursement, was observed in Taiwan after the Outpatient Volume Control Program (OVCP) was implemented. Education on proper coding practices is effective when linked to reimbursement.
Area of Science:
- Health Services Research
- Medical Economics
- Healthcare Policy
Background:
- Physician code creep, altering coding for reimbursement, is understudied in chronic disease patients.
- Existing research primarily focuses on inpatient or procedural coding changes.
Purpose of the Study:
- To investigate physician diagnostic coding practice changes in response to the Outpatient Volume Control Program (OVCP) in Taiwan.
- To assess coding shifts among patients with chronic diseases in tertiary medical centers.
Main Methods:
- Retrospective observational study of four patient cohorts (intervention and control) from January 2016 to September 2017.
- Analysis of outpatient visits based on four diagnostic coding practices related to OVCP monitoring codes.
Main Results:
- Significant decrease in OVCP monitoring codes as primary diagnoses (-73% to -74%) in tertiary centers.
- Substantial increase in non-OVCP monitoring codes as primary diagnoses (+46% to +73%) in tertiary centers.
- Coding practice changes were less pronounced in clinics compared to tertiary medical centers.
Conclusions:
- Physician code creep was evident following the OVCP initiation in Taiwan.
- Educational interventions on appropriate outpatient coding can be effective when reimbursement incentives are aligned.
Background:
Most studies on the physician code creep (i.e., changes in case mix record-keeping practices to improve reimbursement) have focused on episodes (inpatient hospitalizations or outpatient procedures). Little is known regarding changes in diagnostic coding practices for better reimbursement among a fixed cohort of patients with chronic diseases.
Methods:
To examine whether physicians in tertiary medical centers changed their coding practices after the initiation of the Outpatient Volume Control Program (OVCP) in Taiwan, we conducted a retrospective observational study of four patient cohorts (two interventions and two controls) from January 2016 to September 2017 in Taiwan. The main outcomes were the number of outpatient visits with four coding practices: 1) OVCP monitoring code recorded as primary diagnosis; 2) OVCP monitoring code recorded as secondary diagnosis; 3) non-OVCP monitoring code recorded as primary diagnosis; 4) non-OVCP monitoring code recorded as secondary diagnosis.
Results:
The percentage change of the number of visits with coding practice 1 between 2016Q1 and 2017Q3 was - 74% for patients with hypertension and - 73% with diabetes in tertiary medical centers and - 23% and - 17% in clinics, respectively. By contrast, the percentage changes of coding practice 3 were + 73% for patients with hypertension and + 46% for patients with diabetes in tertiary medical centers and - 19% and - 2% in clinics, respectively.
Conclusions:
Physician code creep occurred after the initiation of the OVCP. Education regarding appropriate outpatient coding for physicians will be relatively effective when proper coding is related to reimbursement.
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