另一方面,医生可能会操纵编码,将低分组患者“人为”编入支付标准更高的DRG组以获取更高的医保收入,这也导致部分医疗机构依靠高编码 (up-coding) 而非通过提高诊疗效率和控制成本的方式来提高收益水平[18]。 为控制实施DRG支付可能带来...
Precise coding is an essential requirement in order to generate a valid DRG. The aim of our study was to evaluate the quality of the initial coding of surgical procedures, as well as to introduce our "hybrid model" of a surgical specialist supervising medical coding and a nonphysician for ...
因此,实施DRG必须选择适当的疾病分类方法。实际的DRG分组过程,需要借助计算机进行处理,因而要将DRG的分组过程进行“编码化”(coding)。不同类别的病例通常使用疾病诊断编码来区分,不同的治疗方式使用操作分类编码来区分,而患者的个体特征则以患者的年龄、性别、出生体重(用于新生儿病例的分类)等来表示。显然,疾病的诊断和...
In order to prevent downcoding, DRG grouping should be detailed, and DRG payment should consider how to reflect the value of difficult cases; for upcoding behavior, medical insurance center and relevant medical institutions should check the correctness of coding, and monitor in place. KEYWORDS: ...
DRG validation with Waystar’s Anomaly Detection solution can save your team countless hours while increasing accuracy. Our solution is constantly evaluating changes in coding behavior to ensure all accounts are assessed for potential errors. Request a d
DRG (Diagnosis Related Group) data information audit mechanism is an essential process in healthcare institutions to ensure the accuracy and integrity of medical coding and billing. It involves the review and evaluation of medical records, coding practices, and billing processes to identify any discrep...
(P<0.01). Conclusion In order to prevent moral hazard, reduce the behavior of taking medical insurance fund with high diagnosis and upcoding, clinicians should improve their ideological understanding, standardize their diagnosis and treatment behavior, and control the increase of unreasonable expenses. ...
Does AI Know the Coding Rules? Not yet. Coding rules are Byzantine, but essentially linear. In time, AI may master those rules. Current AI programs do not incorporate the coding rules but review the EMR for “key words”. Is Medical Review and Decision-Making Linear?
CMS contends that the change in DRG coding for stroke is not to award higher payment for a specific drug but rather to recognize the need for overall care for stroke patients as a group. CMS' goal is to make payment relate more closely to resource use, and to recognize that the use of...
□ 医疗保障?MEDICALINSURANCE 《中国卫生经济》第41卷 第9期(总第475期)2022年9月 DRG付费模式下的医保基金监管指标体系构建崔 斌① , 程 斌② , 朱兆芳② , 苏 岱③ , 李 鸣⑥ , 孙 谦④ , 杨 琳⑤摘 要 构建全面实施按疾病诊断相关分组付费后的医保基金监管指标体系,有助于对医疗机构高套编码、...