News / Review reveals payment and coding errors

Commissioners tended to be undercharged for inpatient and accident and emergency care and overcharged for outpatients in 2012/13, according to the payment by results data assurance review.

The review, carried out this year for the first time by Capita on behalf of the Audit Commission, examined almost 34,000 patient episodes or attendances with a value of about £31m. It found average error rates of 16% in A&E, 8% in admitted care and almost 10% in outpatients. This led to undercharging of 0.3% in inpatients and 2.9% in A&E, and overcharging of 1.4% in outpatients.

For the first time, the assurance framework looked at the quality of A&E data and found a high number of errors in data submitted to the Secondary Uses Service. On average almost 25% of investigation codes and 33% of treatment codes in its sample audit inaccurately reflected the care provided, it said.

If this continued into 2013/14, when A&E payment moved from five price bands to 11 healthcare resource groups (HRGs), the A&E error rate in the trusts audited would increase to 23%, it added.

Several issues were consistently identified as the cause of A&E errors, including under-recording of activity, such as drugs used, and investigations undertaken.

Inpatient coding accuracy was affected by a number of factors, including errors in diagnosis coding, particularly in secondary diagnosis. Much of this was the result of inaccurate recording of comorbidities and complexities.

Inpatient errors occurred when coders used discharge summaries that were not comprehensive or inaccurate or differed from the patient’s health record. Paper case notes in poor condition and coders not following national guidelines were other common causes.

Most outpatient errors occurred in procedure codes – only nine of the 48 trusts audited had no procedure recording errors. Often, trusts were charging for outpatient attendances at the first attendance or follow-up attendance rate, rather than for a mandated outpatient procedure HRG when a relevant procedure had been carried out.