Control and Revisory in the DRG System – Case-report

Overview

A group of author discusses in the submitted paper possibilities of control and revisory activities in refunding of hospital careby the DRG system The paper was presented at the symposium of the Society of Revisory Medicine of the J. E. Purkyne, MedicalAssociation at the MEFA Congress 2001 on Nov. 9, 2001 in Brno. As far as I know, by then a single published paper existed (Dr.Jan Calta: „Reimbursement of hospital care by means of the DRG system – its control and participation of revisory activity init“. Zdrav. Pojiš. rev. Lék., 3, 2000, no. 4). Moreover any practical examples or actual experience were lacking. Therefore we triedtogether with colleagues from the General Health Insurance in Hodonín to „map“ this problem based on available data,information and material from this sphere. Based on actual results we try not only to record the problem of control of the DRGreimbursement system and the ratio of revisory activities in this control but also differentiate them and by means of simpleexamples give instructions or elaborate a possible method of control comprising revisory activities. At the same time we drawattention to possible pitfalls and dangerous aspects which must be ensured before a possible change to this method of hospitalfinancing in advance by agreeements and organizational provisions.

Key words:
hospital care – payment for diagnosis (DTG) – diagnosis (dg) – control activity – revisory activity – coding – coder– grouper – revisory – assessment – investigation – method of General Insurance Company – MKN10