Many believe that some hospitals engage in upcoding, an act in which hospitals classify patients into a diagnosis related group (DRG) that yields higher reimbursement from Medicare than the DRG that is justified
of DIP pilot cities have set up medical institution rank coefficients (MIRC), which reflect the proportion of resources consumed by different levels of medical institutions for treating cases within the same DIP group. The higher the medical institution level, the higher the MIRC. Medical institution...
Medical institutions face penalties for violating regulations such as upcoding or splitting hospitalizations. As shown in Fig. 1, the actual reimbursements to a medical institution are the product of the point volume, point value, MIRC, and adjustment factors minus the penalty. The Policymaker aims...
365 Words 2 Pages Open Document In FY 2014, the Department of Justice (DOJ) opened 924 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 496 cases involving 805 defendants. A total of 734 defendants were convicted of health care fraud-related crimes duri...
Many believe that some hospitals engage in upcoding, an act in which hospitals classify patients into a diagnosis related group (DRG) that yields higher reimbursement from Medicare than the DRG that is justified by patients' medical records. For example, hospitals are reimbursed more than twice ...