The Impact of the Clinical Miscoding on Inpatient Reimbursement

Document Type: Original Article


1 Assistant Professor, Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran

2 Assistant Professor, Department of Health Information Technology, Faculty of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Assistant Professor, Department of Health Information Technology, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, Iran


Background: The purpose of this study was to investigate the rate of coding errors and its effect on the amount of correct reimbursement to patients.
Methods: This descriptive and cross-sectional study was performed in 2018. Research resources were records in compensation units in medical documents center of social security organization. A total of 546 records were reviewed of which, 118 records met the research criteria and were selected through census method. Instrument for data collection was a checklist composed of six parts. Data were collected by compensation unit coders.
Results: In total, 118 records met the inclusion criteria. The highest rate of documentation error was related to unconfirmed errors with 106 items and a coefficient of 3845.44. The cost issued to patients based on tariff codes with a coefficient of 9696.4 was estimated as 3684632000 Rials, which only 2416154000 Rials was reimbursed to the patients with the coefficient of 6358.3.
Conclusion: Since coding of diagnostic measures had a high percentage of errors, and the recording of services was not accepted, some proper policies must be adopted to reduce procedure miscoding.



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