What question did this study set out to answer?

To evaluate changes in Medicare hospital coding accuracy and diagnostic overreimbursement between 1985 and 1988 under the prospective payment system.

August 19, 1992JAMA

Medicare reimbursement accuracy under the prospective payment system, 1985 to 1988

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Retrospective audit reveals reduced coding errors and resolved net overreimbursement in Medicare discharges, indicating deterrence of DRG creep.

To evaluate changes in Medicare hospital coding accuracy and diagnostic overreimbursement between 1985 and 1988 under the prospective payment system.
Analyzed a nationwide simple random sample of 2,451 hospital charts for Medicare discharges from 1988.
The American Medical Record Association reabstracted ICD-9-CM codes on a blinded basis, assigned DRGs, and categorized reasons for discrepancies.
DRG-altering coding errors decreased from 20.8% ± 0.5% in 1985 to 14.7% ± 0.7% in 1988.
The proportion of errors resulting in hospital overreimbursement fell to a nonsignificant 50.7% ± 2.6% in 1988 (down from 61.6% ± 1.3% in 1985), leading to no significant net overreimbursement nationally.
Physician misspecification of diagnoses led to underreimbursement, whereas hospital billing department code resequencing drove overreimbursement.

David C. Hsia (1992) studied this question.

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Retrospective audit reveals reduced coding errors and resolved net overreimbursement in Medicare discharges, indicating deterrence of DRG creep.