HCIA-Sachs completes study on upcoding
Detecting and punishing fraud and abuse in health care has become a law enforcement priority for the federal government, and with good reason: An estimated 11% of Medicare claims, worth about $20 billion, are improperly paid each year. In February 1998, as part of the Health Insurance Portability and Accountability Act of 1996 Fraud and Abuse Control Program, the Office of the Inspector General released a set of "compliance program" guidelines to help providers regulate themselves and meet federal standards.
The guidelines identify specific areas of hospital operations that are vulnerable to fraud and abuse. One such area is "DRG upcoding," the practice of using billing codes that provide higher payment rates than the codes that actually reflect the service furnished to patients.
Hospital Compliance and DRG Upcoding, a new study from HCIA-Sachs in Baltimore and Ernst & Young in New York City, studies hospitals’ initial response to the compliance rules pertaining to DRG upcoding. Three years of data are provided for five select DRG pairs. Download the study free from the HCIA Web site: www.hcia.com.
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