Defect Analysis on the First Page of Mistakenly in High-rate Cases under DRG Payment
Objectives By analyzing the high-rate cases in a hospital based on DRG payment,explore the reasons and propose measures to reduce the rate of high-rate cases.Methods Review and study 411 high-rate medical records received from the Medical Insurance Bureau from January 1st,2021 to June 30th,2021,by attending physicians and three coders who passed the Certificate of"International Classification of Diseases and Surgical Operation Classification Coding Skill Level Examination"issued by the Medical Records Management Committee of the Chinese Hospital Association,and collect and check them one by one according to the rules.Focus on quality control discharge diagnosis and surgical operation,and check the consistency with admission records/course records and surgical records,and classify and analyze the defects and abnormalities.Results 30 of the 411 cases mistakenly in high-rate cases.13 were disputed due to DRG grouping scheme,accounting for 43.33%.There were 11 doctors'mistakes in main diagnosis,main operation selection,omission of operation,and wrong filling of admission condition,accounting for 36.67%;The coder omitted surgical procedures,main diagnoses and main surgical coding errors,accounting for 20.00%.Conclusions The main reason that the inpatient medical record front page defects led to the high rate of cases group was the main diagnosis and main surgical selection errors.Through strengthening training and quality control of the whole process of the inpatient medical record front page,the data quality of the inpatient medical record front page was continuously improved,so as to improve the accuracy of DRG inclusion.
Diagnostic correlation grouping(DRG)High-rate caseFront page of medical records
NETL
NSTL
万方数据
