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Weaknesses in code quality in hospitals - Document no. 3:7 (2005-2006)

The Boards and the management of the health enterprises are not adequately exercising their responsibility for establishing systems to secure good quality of the coding of diagnoses. A prime cause of the poor code quality is that one in three doctors has not received systematic training in the regulations. In addition, procedures have not been set up to ensure that coding and quality assurance form part of the general running of the hospitals.
Published 4/5/2006 4:39 PM

These are the main conclusions of The Office of the Auditor General’s investigation of code quality at the hospital enterprises, Document nr. 3:7 (2005–2006) that was submitted to the Storting on 5 April.

The objective of the investigation was to shed light on possible causes of low code quality. A uniform code practice is crucial to ensure that the system of performance-based financing is experienced as fair and functions as a foundation for the financing of the health enterprises. The background for the investigation is a case record audit performed by the Office of the Auditor General (OAG) in 2003 which resulted in a considerable proportion of the hospitalisations studied having their codes changed.

The OAG’s investigation shows that the health enterprises have not defined goals that make it possible to verify whether the desired code quality has been attained. This makes it difficult for the Boards and the management of the health enterprises to monitor whether the regulations for coding are being followed and to check the development of the code quality. Several of the health enterprises also lack guidelines that describe the responsibility and authority of the various groups of staff that are involved in the coding.

The regulations for medical coding are complicated. To code correctly, doctors must therefore be familiar with these regulations and the guidance material. A lack of systematic and coordinated training is the most likely explanation of the fact that almost 40 per cent of doctors are not sufficiently familiar with essential guidance material. The training that is provided appears to be largely dependent on the individual department manager’s interest in medical coding.

Reimbursement through performance-based financing constitutes a large proportion of the health enterprises’ income. The investigation shows that most of the enterprises distribute this reimbursement as far down as the clinical departments. A low code quality will therefore inadvertently affect the distribution of resources among the health enterprises and also among the internal departments of each enterprise.

The OAG would like to point out that good code quality can contribute to more correct and reliable information about results. This in turn will ensure a better utilisation of resources in the health enterprises and will support the enterprises’ managers when they are to make decisions on the distribution of resources and the monitoring of activities and results.

In its comments on the investigation, the Ministry of Health and Care Services states that correct coding is of major importance for the applicability and legitimacy of medical coding for use in research, statistics and management information and thus also as a basis for financing both from the state to the regional health enterprises and within these enterprises.

The document (in Norwegian) can be downloaded from this website or ordered from Akademika booksellers, tel. +47 22 11 67 70.

The provision concerning delayed public access to documents that are compiled by or sent to the Office of the Auditor General in connection with Document no. 3:7 has been repealed, cf. Section 28, paragraph 2 of the Auditor General Act.

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