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week 4 case study

week 4 case study

The average rate of upcoding in the control sample of hospitals (those without a high predicted rate of upcoding) was not statistically different from the average down coding rate. However, among hospitals that the software predicted would have a high rate of upcoding, the average upcoding rate was more than twice that of down coding. The difference between upcoding and down coding in these hospitals suggests intentional abuse of the DRG system by some providers.

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