The Impact of the Clinical Miscoding on Inpatient Reimbursement

Background: The purpose of this study was to investigate the rate of coding errors and its effect on the amount of correct reimbursement to patients. Methods: This descriptive and cross-sectional study was performed in ۲۰۱۸. Research resources were records in compensation units in medical documents center of social security organization. A total of ۵۴۶ records were reviewed of which, ۱۱۸ records met the research criteria and were selected through census method. Instrument for data collection was a checklist composed of six parts. Data were collected by compensation unit coders. Results: In total, ۱۱۸ records met the inclusion criteria. The highest rate of documentation error was related to unconfirmed errors with ۱۰۶ items and a coefficient of ۳۸۴۵.۴۴. The cost issued to patients based on tariff codes with a coefficient of ۹۶۹۶.۴ was estimated as ۳۶۸۴۶۳۲۰۰۰ Rials, which only ۲۴۱۶۱۵۴۰۰۰ Rials was reimbursed to the patients with the coefficient of ۶۳۵۸.۳. Conclusion: Since coding of diagnostic measures had a high percentage of errors, and the recording of services was not accepted, some proper policies must be adopted to reduce procedure miscoding.

Keywords:

Coding , Miscoding , Tariffs , Patient reimbursement