Determine Reliability and Adequacy of Coded Diagnoses and Procedures for ServicesProvided in Physician Office Settings

摘要

This project has explored methods for quantifying the reliability and determiningthe adequacy of coded diagnostic and procedure information reported for services provided in physician office settings. The report describes investigator results from literature reviews, discussions with experts and interviews with physicians. It recommends consideration for a two-phase formal study designed to establish error rates in Medicare claims submission, the extent to which errors are detected in the process, examine the reasons for errors and identify the potential for developing additional processing mechanisms for more completely disclosing coding errors.