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PubMedDate not supplied

Making the most of DRGs.

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Current Procedural Terminology↗
PubMed2002

CPT changes for 2002.

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Current Procedural Terminology↗
PubMedDate not supplied

Manager's reports of variation in coding accuracy across U.S. oncology centers.

Advances in high-speed data processing capabilities, and the increasing reliance on information systems in comparative data assessment, are creating greater dependence on information systems, with a related need for more timely assessment of coding quality. Assessing the accuracy of coded and classified data becomes critical as the implementation of government compliance management requirements, along with the growing adoption of evidence-based medicine in error detection, serve to challenge healthcare researchers to consider the quality of coded data in management assessments. The implementation of larger, faster and more comprehensive databases in healthcare delivery settings is one response to this changing environment, but at a national level there will need to be some degree of uniformity in their utilization and management, if researchers are expected to rely on comparative benchmarks to fully assess organizational performance. In a nationwide survey of health information managers we found about 81 percent of respondents reported that significant coding errors existed in 5 percent or less of the records in their institutions. About 11 percent of respondents, however, reported that the coding errors existed in six to ten percent of their records. Regional and practice setting variation in reported coding error ranged widely, occurring across organizations as well as area locations. Related impact on comparative data-driven management assessment is discussed.

Abstracting and Indexing↗
PubMedDate not supplied

2003 coding update.

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Aortic Aneurysm, Thoracic↗
PubMed2002

National Hospital Discharge Survey: 2000 annual summary with detailed diagnosis and procedure data.

OBJECTIVES: This report presents national estimates for 2000 and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by demographic characteristics of patients discharged, geographic region, ownership and bed size of hospitals, principal expected source of payment, conditions diagnosed, and surgical and nonsurgical procedures performed. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 2000, data were collected for approximately 313,000 discharges. Of the 481 eligible non-Federal short-stay hospitals in the sample, 434 (90 percent) responded to the survey. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. The population estimates used to compute rates were based on the 1990 Census. Estimates of first-listed diagnoses, days of care, all-listed diagnoses, and all-listed procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). RESULTS: An estimated 31.7 million inpatients were discharged from non-Federal short-stay hospitals in 2000. These patients used an estimated 155.9 million days of care. Females had 19.2 million discharges compared with 12.5 million for males. Fifty-four percent of all discharges under age 65 years had a principal expected source of payment from a private source, and 22 percent were covered by Medicaid. Discharge rates per 1,000 population ranged from 85.4 in the West to 135.5 in the Northeast. The leading discharge diagnosis was delivery for patients under age 65 years and heart disease for those 65 years of age and over. The rate of discharges with coronary artery bypass graft for males was 2.4 times the rate for females, and males had almost twice the female rate for discharges with removal of coronary artery obstruction. Hospital stays were 1 day or less for 15 percent of women with deliveries in 2000, compared with 37 percent in 1995.

Adolescent↗
PubMedDate not supplied

Medicare cost controls and program compliance: the rationale of physician claims edits.

This article attempts to demystify and create a context for the enactment of several Medicare cost control and compliance systems for physician reimbursement. The focus is on claims "edits" and Medicare compliance. Portions of Medicare, including health care provider reimbursement, remain fee-for-service programs that can be easily defrauded. To protect the Trust, the Centers for Medicare and Medicaid Services (CMS) has taken a multi-pronged approach, using program administration, enforcement, and rules-based claims editing systems. The Evaluation and Management codes, the Correct Coding Initiative (CCI), and medical necessity rules are claims edits that affect procedure codes. The Medicare program has a complicated system of billing procedures and an apparatus to enforce them. A solid compliance plan must incorporate proper claims editing, because consistent incorrect Medicare billing can be considered abuse. Many resources are available to aid physicians, including computerized tools, new CMS initiatives, and Internet materials.

Aged↗
PubMedDate not supplied

Improve compliance and financial performance at the same time.

Contrary to conventional wisdom, which holds that compliance is often a net negative to a practice's financial performance, the fact is that compliance, operations, and the financial performance of a medical practice can all be simultaneously improved. This article will illustrate that the basic drivers of effective compliance are often the same fundamental business principles that lead to outstanding operations and enhanced financial performance. The lesson for medical practice managers is that if you improve compliance, you should actually improve your bottom line, not harm it.

Accounts Payable and Receivable↗
PubMed2003

[Diagnosis and procedure coding in relation to the DRG system].

INTRODUCTION: The aim was to investigate the consequences of missing or wrong diagnoses and procedure codes in relation to the DRG system. MATERIAL AND METHODS: All patients admitted to the orthopaedic department during the course of one week, 155 patients, were consecutively entered. Former diagnoses were registered from interviews with all the patients, former case notes, and present hospital records. They were then compared to the department case notes, including diagnosis and procedure codes. All codes were then compared in Visual DRG (version 97) for grouping. RESULTS: The coding was correct in 103 of 155 cases (65%). In 52 cases (35%) the coding was incorrect or insufficient, in 18 of the 52 cases (12% overall) it lead to a decrease in the DRG value, which extrapolated on a yearly base, would lead to a loss of DDK 23 million. In total, coding was incorrect or insufficient in one third of the records. DISCUSSION: Irrespective of whether the DRG system is implemented or not, it is important that departments register the correct diagnoses and procedures, not only those relevant to the department. There is a continued need to teach and inform the staff about the correct coding procedures.

Current Procedural Terminology↗