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Prevalence of Incorrect Billng

Prevalence of Incorrect BillngIncorrect DRG billings are largely a result of human error on the part of hospital coding department personnel, although analysis of provider-specific errors may suggest the possibility of a culture of ”up-coding” in some facilities. Some of the most common factors associated with coding errors are:
  • Extensive and complex coding guidelines, along with yearly CMS updates and changes to the Official Guidelines for Coding and Reporting, and quarterly updates of Coding  Clinic advice.
  • Broad variances in hospital coders’ education and competencies
  • Increasingly higher production goals for hospital coders, associated with revenue cycle management and expectations.
  • Widespread “documentation improvement” initiatives by hospitals that may lead to over-stating of diagnoses and procedures.  
  • Use of “optimizing” coding software
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