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Data Quality

An Illustration of Its Potential Impact Upon a Diagnosis-Related Group??s Case Mix Index and Reimbursement

Bibliographic Data

ID9100428
AuthorsHarvey D Doremus, H Doremus (University Hospitals of Cleveland), Elana M Michenzi (University Hospitals of Cleveland)
Year1983
Volume21
Issue10
Pages1001-1011
Publication date1983-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-198310000-00006
OpenAlexW4366076361
LanguageEN
Citations received3

The Health Care Finance Administration has developed a Medicare reimbursement methodology that will include an adjustment factor for hospital case mix. The patient classification scheme proposed for use in determining a hospital's case mix is the AUTOGRP Diagnosis-Related Groups (DRG) methodology developed at Yale University. The reliability of a case mix measure calculated using the DRG methodology is dependent on complete and accurate diagnostic and surgical data. The source of this data for the HCFA data base (MEDPAR) is the Medicare billing form, which is based on the patient medical record. Data from the MEDPAR file, the original medical record discharge order, and a reabstracted record are compared and analyzed for their effect upon DRG classification and the resultant Medicare reimbursement ceiling for one large teaching hospital. The study results show widely divergent diagnostic and surgical data that results in a significant variation in DRG classification and reimbursement ceilings

Case mix index · Classification scheme · Data science · Diagnosis-related group · Health care · Health care financing · Hospital discharge · Intensive care medicine · Medical record · Quality (philosophy) · Reimbursement · Reliability (semiconductor) · Computer Science · Medical Coding and Health Information · Medicine · Nursing · Surgery

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Unique citing works3
Citations per year0,11
Citation span1998 - 2025 (28)
Citation velocityrecent
Highly citedNo
Citation typesNeutral: 3

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