Coded data quality for Casemix payment: insights from two external audits
نویسندگان
چکیده
Introduction Australia is currently undergoing a change in the Casemix payment environment. This is the result of an agreement to move to a more nationally-consistent approach to activity-based funding (ABF) for services provided in public hospitals. ABF for acute inpatients will be based on the Australian Refined DRG Casemix system, which is derived from the coded clinical data from each hospital admission. Thus, there will be a need to audit the clinical coding to assess the quality of the data in order to determine if the payments based on that coding are correct. In 2009 and 2010, Pavilion Health conducted two major audits of clinical coding in NSW and Queensland. Together, these audits included 55 hospitals and 6,300 records. This paper discusses the insights gained from these two audits.
منابع مشابه
Findings of the national PbR data Assurance Framework: improving the quality of data underpinning payment by results using benchmarking to target clinical coding audits
Introduction Since 2003/04 the Department of Health (DH) has been progressively implementing a prospective payment casemix funding system, known as Payment by Results (PbR), so that in 2008/09 over 90 percent of acute inpatient activity is reimbursed through PbR. The accuracy of the data recorded for each episode of care can directly influence the accuracy of reimbursement between commissioners...
متن کاملQuality and payment: the U.S. experience of typing inpatient and outpatient casemix payments to quality measures and reporting
Introduction Over the past four to five years, the focus in casemix-based payment systems in the United States has shifted more and more towards "value-based-purchasing" and "payfor-performance" measures. The reporting of pre-set quality indicators is now fundamentally in place for both the inpatient prospective-payment system, based on Medicare-Severity Diagnosis Related Groups (MS-DRGs), and,...
متن کاملCasemix classification payment for sub-acute and non-acute inpatient care, Thailand.
BACKGROUND There is a need to develop other casemix classifications, apart from DRG for sub-acute and non-acute inpatient care payment mechanism in Thailand. OBJECTIVE To develop a casemix classification for sub-acute and non-acute inpatient service. MATERIAL AND METHOD The study began with developing a classification system, analyzing cost, assigning payment weights, and ended with testing...
متن کاملThe impact of Casemix system on quality of patient care in a Class B hospital in west Sumatera Province, Indonesia
Background Health spending in Indonesia is on the increase every year due to a number of factors including change in pattern of diseases towards chronic and non-communicable conditions, priority on curative care rather than preventive services, use of new technology in health services and use of fee-for-service for provider payment. Raise in health care cost can have negative impact on accessib...
متن کاملDeveloping sub-acute, non-acute and special groups in the universal grouper
The use of Casemix system as providers’ reimbursement method under social health insurance schemes has spread beyond high-income countries. Over the last decade many low and middle-income countries (LMIC) have started to implement Casemix system to replace the conventional yet inefficient fee-for-service as provider payment mechanism. UNU-IIGH launched an international grouper called UNU-CBG in...
متن کامل