Medicare reimbursement accuracy under the prospective payment system: 1985 to 1988
Article Abstract:
Coding errors for hospitalized Medicare patients assigned to diagnosis related groups (DRG) declined from 20.8% in 1985 to 14.7%. In 1985, 61.6% of errors resulted in overreimbursement hospitals, increasing net reimbursement by 1.9%, or $308 million nationally. Coding errors are usually due to either a diagnosis not supported by the medical record, miscoding by the medical records department or substitution by hospital employees of a secondary diagnosis for a correctly coded principal diagnosis (resesquencing). By 1988, coding errors had been reduced to 6.1%. These errors did not overreimburse the hospitals. However the proportion of discharges overreimbursing hospitals has not changed, possibly due to resequencing . Coding errors which cause overreimbursement, DRG "creep", may have been diminished because of current requirements for the physician to certify the correctness of the patient's narrative diagnosis and procedures, requirements which do not exist for hospital personnel.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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Structured advance planning: is it finally time for physician action and reimbursement?
Article Abstract:
Advance directives for medical care have a better chance of being carried out if physicians are involved. The directive must be brought to the physician's attention. One way of doing this is by having the physician cosign advance directive documents to ensure a higher rate of compliance. Worksheets for advance directives can be provided in health care facilities for easy use. Physicians can learn how to conduct advance planning sessions. Hospitals and health care facilities are required to ask about advance directives under the Patient Self-determination Act. Structured advance planning is a new field still in its development stages, and improvements are under way.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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Method of Medicare reimbursement and the rate of potentially ineffective care of critically ill patients
Article Abstract:
HMOs may be better at reducing the level of inappropriate care given to critically ill patients who are dying. This was the conclusion of a study that evaluated potentially ineffective care (PIC) in all critically ill Medicare patients in intensive care units in California in 1994. PIC is defined as extensive provision of health care resources to a patient who dies shortly thereafter. About 5% of the patients received PIC and they used 22% of the total ICU resources in the state that year. HMO members were less likely to receive PIC compared to fee-for-service patients.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1997
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