Medicare Reimbursement Accuracy Under the Prospective Payment System, 1985 to 1988
JAMAPublished 19 August 1992
David C. Hsia
Citations154
SJR quartileQ1
SJR score5.35
SNIP10.71
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TL;DR
The attestation requirement may have deterred DRG creep due to attending physician upcoding, but the peer review organizations' sentinel effect and educational activities have not eliminated hospital resequencing.
Abstract
The attestation requirement may have deterred DRG creep due to attending physician upcoding, but the peer review organizations' sentinel effect and educational activities have not eliminated hospital resequencing.
Keywords
Health Professions
Primer of biostatistics
2,644 Citations1981Stanton A. Glantz
New England Journal of MedicineAccuracy of Diagnostic Coding for Medicare Patients under the Prospective-Payment System
494 Citations1988David C. Hsia, W. Mark Krushat +3 more
It is concluded that "creep" does occur in the coding of DRGs, resulting in overpayment to hospitals for patients covered by Medicare, and a statistically significant 61.7 percent of coding errors favored the hospital.
Journal of Health EconomicsHow much change in the Case Mix Index is DRG creep?
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Most of the additional $1 billion paid to hospitals because of the Case Mix Index change appears justified by the additional complexity of patients hospitalized.
PubMedEvaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects.
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The hospital discharge diagnoses index for newborns and the birth certificate were evaluated as sources of information about birth defects by comparing them with the same births in the case registry of the California Birth Defects Monitoring Program.
PubMedDiagnosis related group coding accuracy of the peer review organizations.
6 Citations1992Hsia Dc
The accuracy of the peer review organizations' abstraction of DRGs during federal fiscal year 1985 was determined, with a significantly lower proportion than the 80.3 percent paid accurately by the fiscal intermediaries.
PubMedDRG "creep". Pitfalls and sanctions to avoid.
2 Citations1989Richard P. Kusserow, B L Steeley
Physicians' recognition of the importance of their responsibility to designate complete and accurate diagnostic and procedural information can help avoid problems, including the potential for sanctions against physicians who unwittingly contribute to fraud and abuse.