BC Advantage - 2007 Issue 11

Medical versus Surgical DRGs: Problems with inpatient stays?

Hospitals monitoring for potentially unnecessary admissions recently obtained another tool to hone in on problematic areas. This new tool is a data report that can help hospital staff dig deeper into one-day stays. As evidenced by a recent discussion on Medicare payment errors, there is a high percentage of errors associated with one-day inpatient hospital stays. An analysis of a random sample of Medicare claims from fiscal year (FY) 2005 identified 18 percent of all one-day stay admissions as having payment errors, compared to a nine percent error rate overall for all cases sampled. A large proportion of...

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