Magazine article Public Finance

Studies Find 'High' Coding Errors for Payment by Results

Magazine article Public Finance

Studies Find 'High' Coding Errors for Payment by Results

Article excerpt

Inaccuracies in the way hospitals code the activities they perform to bill primary care trusts 'undermines' the payment by results regime, the Audit Commission has warned.

Pilot studies across two health economies involving 12 acute trusts found that, on average, 12% of diagnosis and procedure codes were inaccurate, representing between 5% and 14% of total value of payment by results transactions.

'The reported level of... error seems intuitively too high, particularly in a system where clinical coding is the primary determinant of payment,' says the December 7 report Payment by results assurance framework.

'The level and nature of clinical coding error is not so high as to destabilise the PBR regime, but it does undermine it, raising concerns about the accuracy and fairness of funding flows'

The report found evidence of over-coding' - logging more procedures than carried out and of 'trusts actively working to optimise their coding to maximise income.'

But Andy McKeon, the Audit Commission's head of health audit, told Public Finance they found 'no evidence of fraud or manipulation'.

The report was commissioned by the Department of Health to ascertain whether a systematic audit process for assuring the accuracy of payment by results bills was necessary. …

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