From 2009, morbidity measured by medical diagnoses and its change over time will be one of the factors to determine the remuneration of physicians in Germany. Other factors include changes in the scope of medical serv...
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From 2009, morbidity measured by medical diagnoses and its change over time will be one of the factors to determine the remuneration of physicians in Germany. Other factors include changes in the scope of medical service profiles and in the development of practice costs. In preparation of the physician payment reform, the National Association of Statutory Health Insurance Physicians (KBV) started to introduce measures in 2004 to check the plausibility of diagnosis codes recorded in the ambulatory care setting to prevent coding errors. Their development has been supported professionally by the Central Research Institute of Ambulatory Health Care (ZI), which continues to analyse the outcome of these measures. Theresults in coding improvements are illustrated using a time series. We compare the frequencies of errors from the first quarter of the year 2000, in which coding based on a German version of the ICD-10 became mandatory in ambulatory care, up to the first quarter of 2006. A notable decline in the frequencies of all monitored coding errors after the introduction of an obligatory automated plausibility check for recorded diagnoses in 2005 can be demonstrated. This automated plausibility check which is embedded in all practice data processing systems applies to obvious coding errors (implausible reference to age and sex, and "exotic'', very rare and notifiable diseases). The introduction of the morbidity-related payment system is likely to raise the necessary quality standards for coding. Automated plausibility checks contribute to improved codingquality while minimizing the efforts physicians need to make.
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