Magazine article Public Finance

Payment by Results 'Undermined' by Coding Errors

Magazine article Public Finance

Payment by Results 'Undermined' by Coding Errors

Article excerpt

An Audit Commission study revealing significant levels of error in the coding that underpins the payment-byresults system should be a call to action for both providers and commissioners, NHS leaders have said.

Results of the commissions first clinical coding audit programme revealed an average 9.4% error rate on Healthcare Resource Group assignments - the system under which diagnostic and treatment procedures are grouped and which determines the tariff. The average error rate for coding the individual procedures was even higher, at 16.5%.

The August 28 report also uncovered huge variations in trusts' performance. While some recorded an HRG error rate of 0.3%, one trust s error rate was 52%.

Variation in the error rates identified at procedure coding level was wider still, with trusts ranging from close to zero to more than 70%.

Nigel Edwards, policy director at the NHS Confederation, told Public Finance that the results justified the need for the study.

'This is an important report that needs attention paying to it,' he said. 'We should get to a point where it shouldn't be needed every year, [but] commissioners and providers are going to have to pay some quite serious attention to documentation, systems, training of the coders and the internal quality control that they operate because there are significant sums of money that swing on this!

The Audit Commission checked the coding quality of 300 consultant episodes' (periods of continuous treatment under a consultant) from every acute trust It found the errors contributed to a gross financial error of around £3.5m, approximately 5% of the price of the sampled treatments.

Andy McKeon, managing director for health at the Audit Commission, said: 'In most cases, not in every case, the positives and negatives cancelled each other out, so the net error was close to zero.

'We say, with reasonable confidence, that there's no evidence that there is systematic gaming or manipulation of the data to secure higher payments.'

But Edwards said this risk of gaming' was dwarfed by the more significant problem of inaccurate coding.

'You can't game it if you can't get it right,' he said. 'There isn't a sufficiently high level of accuracy that would be acceptable in payroll. If you imagine this level of error in payroll you'd be changing the contractor.'

The Audit Commission found the most common factor affecting accuracy was poor source documentation. Information passed on to coders by clinicians was not robust enough, it said. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.