219280 Costs of DRG-Upcoding due to the introduction of the Diagnosis Related Groups in Germany

Wednesday, November 10, 2010 : 8:50 AM - 9:10 AM

Tonio Schoenfelder , Department of Public Health, Dresden Medical School, University of Dresden, Dresden, Germany
Joerg Klewer, MD PhD , Faculty of Public Health and Nursing Sciences, University of Applied Sciences Zwickau, Zwickau, Germany
As part of the reform of the German health care system, the existing retrospective and procedural reimbursement system was replaced by a prospective and diagnostic system based on DRG. One objective was to reduce health care costs in the in-patient sector. However, the introduction of the DRG-based remuneration of the German health care system in 2004 has not controlled its rising expenditure. This increase has various causes with DRG-Upcoding forming a component thereof.

Until now, the upcoding expenditures in the German DRG-system have not been assessed. This presentation aims to give an overview of the excess of upcoding costs since the implementation of the DRG.

Literature on the extent of DRG-Upcoding was found by databank research. Calculations based on data regarding the US prospective payment system and data of the Federal Statistical Office of Germany regarding the costs of the in-patient sector.

The expected additional expenditure in the German healthcare system due to upcoding from 2004 to 2009 was around 1.9 to 3.24 billion . The costs of defrauding coding practices were estimated to 288 million to one billion .

An overview of upcoding expenditures can be drawn from these computations. To gain the exact upcoding costs in Germany, additional analysis of the CMI-components in the G-DRG-system are required.

Learning Areas:
Administration, management, leadership
Program planning
Public health or related research

Learning Objectives:
Describe how modifications performed on a reimbursement system effects the systems future expenditures Discuss a method for assessing health care costs in a DRG-system, identify costs of defrauding coding practices

Keywords: Coding, Financing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I made substantial contributions to conception, analysis and interpretation of the study data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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