From downcoding to upcoding: DRG based payment in hospitals
From downcoding to upcoding: DRG based payment in hospitals (Springer).
A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital’s payment rule to imply. The secret of this payment is a fee payment as well as a hospital’s activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per
group depends on recorded information that is then processed using complex
algorithms. What if the data itself can be manipulated?
[...]
The end result has been a budget transfer from public non-research hospitals to
for-profit hospitals. The 2009 policy lead to upcoding disconnected from any
changes in the trend of production of care.
Quelle: Springer, 31.10.2020
