Since 2007 the Audit Commission has delivered an assurance programme for Payment by Results (PbR), the NHS tariff for paying acute hospitals. This work comprises analysis, research, pilot reviews, benchmarking and an audit programme that has checked the accuracy of over £200 million of payments under PbR. The focus of our work is to improve the quality of data that underpins payment under PbR, but the data reviewed is also of wider importance to the NHS as it is used to plan and monitor healthcare provision. It also supports effective commissioning. This report summarises the findings from three years of the independent external clinical coding audit programme. It also outlines the findings from outpatient reviews undertaken at all acute trusts.
The report finds that the accuracy of clinical coding is improving year-on-year. At the start of the programme, average clinical coding errors at trusts were 16 per cent. This reduced to 11 per cent, but that still equates to approximately £9 million of financial errors because of this wrong data. Despite the overall improvement in clinical coding nationally, there is still significant variation between the best and the worst-performing trusts. HRG error rates range between 0 and 28 per cent. The clinical coding error rate range is similar. Trusts are implementing many recommendations which is improving coding accuracy and strengthening the integrity of payment. To continue to improve data quality, the report makes a series of recommendations for primary care trusts and NHS trusts to consider.
NHS Trusts need to make sure that: regular internal audits on clinical coding and the quality of outpatient data are carried out; clinical coders are well trained and follow national standards; clinicians are engaged in improving the accuracy of inpatient and outpatient data; policies and procedures for data quality and capture are up to date; and medical records are of a good quality, accurate and are readily accessible to those inputting data.