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支付可能带来的...
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
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...
(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. ...
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? No. Medicine and medical decision making is not linear. While there are criteria (e.g. sepsis,) they require ...
□ 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、...
If the legislator takes the necessary actions to reduce possible negative effects like manipulation and upcoding, the introduction of G-DRGs will lead to an increase in economic effectiveness and efficiency, while bringing more transparency into the quality of medical services at the same time....
Analysis on the Coding Defects of Abnormal Cases Included in Gynecology Department Based on CHS-DRG 引用 收藏 分享 摘要 目的 分析某院妇科DRGs分组异常病案疾病编码过程中存在的问题,提出解决对策,持续改进编码数据质量。方法 从广西壮族自治区医保局反馈的3年CHS-DRGs分组,回顾性分析2017年1月1日-2019年12月...
This study found that the screening mechanism of DRG high-rate cases was unreasonable, and the hospital's medical record coding ability and medical service ability were insufficient. It was likely to appear moral hazard, and high-rate problem was more possible to happen in low-weight cases. In...