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The Impact of the Clinical Miscoding on Inpatient Reimbursement

عنوان مقاله: The Impact of the Clinical Miscoding on Inpatient Reimbursement
شناسه ملی مقاله: JR_JKMU-27-2_008
منتشر شده در در سال 1399
مشخصات نویسندگان مقاله:

Roghayeh Ershad Sarabi - Assistant Professor, Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
Soodeh Shahsavari - Assistant Professor, Department of Health Information Technology, Faculty of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
Ali Mohammadi - Assistant Professor, Department of Health Information Technology, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, Iran

خلاصه مقاله:
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.

کلمات کلیدی:
Coding, Miscoding, Tariffs, Patient reimbursement

صفحه اختصاصی مقاله و دریافت فایل کامل: https://civilica.com/doc/1582697/