DRG "creep". Pitfalls and sanctions to avoid.

Abstract

In 1983, with the advent of the Medicare prospective payment system, the physician's role became crucial in determining a hospital's reimbursement for treatment of a Medicare patient. The correct diagnosis-related group assignment depends upon the physician's accurate designation of the primary and secondary discharge diagnoses. Manipulation of this information can result in an inaccurate payment, and the physician is ultimately responsible for the misrepresentation. Physicians' recognition of the importance of their responsibility to designate complete and accurate diagnostic and procedural information can help avoid problems, including the potential for sanctions against physicians who unwittingly contribute to fraud and abuse.