A Statistical Model to Detect DRG Upcoding

Abstract

The Medicare program, private insurers, and managed care organizations reimburse hospitals for inpatient admissions using the Diagnosis Related Group (DRG). The DRG is determined from a complicated algorithm based on patient medical records. Previous studies generated concerns about ‘DRG upcoding’, in which incorrect DRG codes may be selected by the… (More)
DOI: 10.1023/A:1011491126244

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@article{Rosenberg2004ASM, title={A Statistical Model to Detect DRG Upcoding}, author={Marjorie A. Rosenberg and Dennis G. Fryback and David A. Katz}, journal={Health Services and Outcomes Research Methodology}, year={2004}, volume={1}, pages={233-252} }