PCTs lose money through incorrect clinical coding

Hospitals are overcharging PCTs by up to 14 per cent because of incorrect clinical coding, an Audit Commission report has revealed.

In some trusts, more than a quar-ter of clinical coding was wrong, the report found.

Some of the errors could be evidence of fraud, the report sug-gests. It highlights ‘concerning practice’ in some areas in which clinical coding teams report to fi-nance directors to ‘discuss the fi-nancial impact of coding changes on a regular basis’.

This practice ‘increases the like-lihood of manipulation’, the report says.

The scale of erroneous reporting is undermining the Payment by Results tariff system for paying hospitals, ‘raising concerns about the accuracy and fairness of fund-ing flows’.

The report calls for the DoH to introduce set financial penalties that would cut pay for the worst offenders by the end of 2006/7.

It also calls for a large-scale audit system to detect errors or fraud by trusts, which would cost up to £30,000 per PCT to implement.

The findings could have negative implications for GPs’ ability to control spending and generate savings under practice-based commissioning.


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