Kusserow R P, Steeley B L
Consultant. 1989 Mar;29(3):93-5, 98-9.
In 1983, with the advent of the Medicare prospective payment system, the physician's role became crucial in determining a hospital's reimbursement for treatment of a Medicare patient. The correct diagnosis-related group assignment depends upon the physician's accurate designation of the primary and secondary discharge diagnoses. Manipulation of this information can result in an inaccurate payment, and the physician is ultimately responsible for the misrepresentation. Physicians' recognition of the importance of their responsibility to designate complete and accurate diagnostic and procedural information can help avoid problems, including the potential for sanctions against physicians who unwittingly contribute to fraud and abuse.
1983年，随着医疗保险预付费制度的出现，医生在确定医院对医疗保险患者治疗费用的报销方面发挥了关键作用。正确的诊断相关分组取决于医生对主要和次要出院诊断的准确指定。对这些信息的操纵可能导致报销不准确，医生最终要对虚假陈述负责。医生认识到他们有责任指定完整和准确的诊断及程序信息的重要性，有助于避免问题，包括对无意中助长欺诈和滥用行为的医生实施制裁的可能性。
