title: DRG benchmarking study establishes national coding norms.
abstract: With the increase in fraud and abuse investigations, healthcare financial managers should examine their organization's medical record coding procedures. The Federal government and third-party payers are looking specifically for improper billing of outpatient services, unbundling of procedures to increase payment, assigning higher-paying DRG codes for inpatient claims, and other abuses. A recent benchmarking study of Medicare Provider Analysis and Review (MEDPAR) data has established national norms for hospital coding and case mix based on DRGs and has revealed the majority of atypical coding cases fall into six DRG pairs. Organizations with a greater percentage of atypical cases--those more likely to be scrutinized by Federal investigators--will want to conduct suitable review and be sure appropriate documentation exists to justify the coding.
authors.affiliation: QuadraMed Corp., Neptune, NJ, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Vaul
mesh_terms: D000043:Abstracting and Indexing / Q000145:classification* / Q000379:methods; D019985:Benchmarking; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics; D005377:Financial Management, Hospital / Q000379:methods*; D007344:Insurance Claim Reporting; D007902:Length of Stay; D008499:Medical Records / Q000145:classification; D006278:Medicare; D016311:Outliers, DRG / Q000191:economics; D014481:United States