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Use of Risk Adjustment Models for Provider Reimbursements

Use of Risk Adjustment Models for Provider Reimbursements

Patricia Cerrito
Copyright: © 2010 |Pages: 29
ISBN13: 9781605667522|ISBN10: 1605667528|EISBN13: 9781605667539
DOI: 10.4018/978-1-60566-752-2.ch010
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MLA

Patricia Cerrito. "Use of Risk Adjustment Models for Provider Reimbursements." Text Mining Techniques for Healthcare Provider Quality Determination: Methods for Rank Comparisons, IGI Global, 2010, pp.357-385. https://doi.org/10.4018/978-1-60566-752-2.ch010

APA

P. Cerrito (2010). Use of Risk Adjustment Models for Provider Reimbursements. IGI Global. https://doi.org/10.4018/978-1-60566-752-2.ch010

Chicago

Patricia Cerrito. "Use of Risk Adjustment Models for Provider Reimbursements." In Text Mining Techniques for Healthcare Provider Quality Determination: Methods for Rank Comparisons. Hershey, PA: IGI Global, 2010. https://doi.org/10.4018/978-1-60566-752-2.ch010

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Abstract

In this chapter, we will focus on the use of patient severity indices to determine the reimbursement to healthcare providers. In order to do this, we must first examine the standard practice of reimbursing hospitals for specific DRG codes, and for reimbursing other providers based upon a point system that designates the level of service. We especially want to investigate the problem of upcoding, or “gaming” in more detail to determine if it can be detected and corrected, so that providers are reimbursed based upon the actual level of care, and not upon better coding practices.

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