The Impact of Casemix Reimbursement on Hospital Revenue in Indonesia (Kesan Pembayaran Casemix pada Pendapatan Hospital di Indonesia) / Jurnal Sains Kesihatan Malaysia

@#The objective of this study is to examine the impact of the casemix reimbursement on the hospital revenue at three selected hospitals (Type B, C and D) reimbursed using 602 groups from 14,749 cases. The results of the study showed that the hospitals received 32.4% higher income when reimbursed with Indonesia Case Bases Groups (INA-CBG) as compared to fee-for-service. Type D hospitals is the biggest gainer with 81.0% increased in income followed by Type B hospital that obtained 34.7% higher revenue. In conclusion, the use of INA-CBG as a prospective payment method has benefitted the hospitals by the increase in the revenues. It is hope that additional resources gained in this programme will allow the hospitals to provide optimum care to the population. It is recommended that the JKA management will use the INA-CBG casemix data to monitor the performance of the hospitals to ensure that quality and efficiency of the services provided to the population is continuously maintained.

Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia.

BACKGROUND: The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia. METHODS: Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. RESULTS: Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG® code was RM654,303.91. CONCLUSIONS: The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

Incidence Of Clinical Coding Errors And Implications On Casemix Reimbursement In A Teaching Hospital In Malaysia

@#Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital’s income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient’s medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O&G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.

Quality Coding of Malnutrition under the Casemix System in Hospital Universiti Sains Malaysia

Introduction: Detailed clinical information is important for the Casemix System to generate valuable Case Based Group (CBG) for malnourished geriatric patients. Clinical coding for malnutrition provides useful information on the nutritional health of patients for treatment purposes. Methods: This cross-sectional study with purposive sampling involved a total of 130 geriatric patients (>60 years) at Hospital Universiti Sains Malaysia (USM). Nutritional assessments were performed such as anthropometrics measurement, Subjective Global Assessment (SGA), and biochemical assessment. The patients’ medical records and coded data were systematically reviewed to observe the documentation of nutritional information and coding criteria based on the International Classification for Diseases (ICD-10). Results: The prevalence of malnutrition among the geriatric patients was 35.4%. Proper documentation of required nutritional information was found in less than 50% of the cases. None of the malnourished patients were documented and coded with malnutrition diagnosis, despite being given nutritional interventions. The reasons given for this omission were related to the lack of awareness (50%) and incomplete medical documentation (50%). Further analysis revealed that uncoded diagnosis, miscoding, missing, and unavailable codes for nutritional counselling and oral nutritional supplementation were the main contributors to the incomplete records. Conclusion: The quality of clinical coding for malnourished geriatric patients in the hospital should be improved. A structured assessment and standard documentation is recommended to improve the quality of healthcare provision for malnourished geriatric patients.

Developing An E-Learning Education Program For Casemix System; Process And Out Come

Realizing the huge potential of e-learning in casemix education and since there was no e-learning program on casemix and clinical coding available globally. International Centre for Case-mix and Clinical Coding (ITCC) proposed to establish a universal case-mix education programs through providing an e-learning program (ELP) for case-mix and clinical coding and evaluate its success. The aim of this study is to describe the process of development of e-learning program for casemix system and clinical coding. The introduction of course about casemix and clinical coding was redesigned for e-learning program by applying ADDIE model (refer to Analysis, Design, Development, Implementation, and Evaluation).A total number of 57 learners attended to the course from around the world (40 different countries). The mean age of subjects was 34.70±8.66 years. Regarding profession, the largest percentiles (40.4%) of e-learners were belonging to academic sector and healthcare sector. All of the participants felt satisfied or very satisfied with the program. There was a significant difference between pre-test and post-test for e-learners knowledge score at the 0.05 alpha levels. The findings of the evaluation of the case-mix e-learning program indicated that e-learners found the educational performances of the case-mix online program to be satisfactory. With the advent of modern computer networking systems, organizations can employ these systems to enhance learning and performance improvement of case mix system.