The MalaysianDRG Casemix System: Financial Implications of Inaccurate Clinical Documentation and Coding Error

ABSTRACT

@#Introduction: A casemix system measures costs of health service provision that is crucial in the planning and hospital budgeting. The MalaysianDRG casemix system has been implemented since 2010, yet many health professionals were unaware of its importance. To highlight this problem, we estimated the miscalculation of costs in providing treatment, that occurred due to inaccurate clinical documentation and coding error in the MalaysianDRG casemix system. Methods: Using a cross-sectional study design, 226 coded case notes from two healthcare institutions in Malaysia were selected and re-coded. If a difference between codes was observed, the new code would be chosen as the final code. The cases were then re-grouped using the MalaysianDRG casemix system. The cost per case derived from the new and original codes was compared. Then, the outcomes were verified by a casemix expert from the Ministry of Health. Results: Results indicated 61.9% inaccurate clinical documentation and 25.2% coding error. The difference in costs of treatment provision, due to inaccurate clinical documentation was RM227,657 and RM 68,216 for coding error. Using paired t-test analysis, differences between mean (SD) cost per case of the original vs. new codes due to inaccurate clinical documentation [RM10,208.19(12273) vs. RM11,244.53(13785.27), p<0.05], and coding error [RM10,208.19(12273.04) vs. RM11,215.52(13798.03) p<0.05] were statistically significant. These results raised important questions regarding costly financial implications arising from inaccurate clinical documentation and coding error in the MalaysianDRG casemix system. Conclusion: To achieve the full benefit of the MalaysianDRG casemix system, the quality and accuracy of its data must first be established.