High-Risk Medicare-Severity Diagnosis-Related Groups (MS-DRGs) You are the codin
ID: 345914 • Letter: H
Question
High-Risk Medicare-Severity Diagnosis-Related Groups (MS-DRGs)
You are the coding supervisor at a 250-bed acute care hospital. The facility averages about 1050 discharges per month. About 41% of the discharges are Medicare. You have been given the responsibility of ensuring that there are no problems with the OIG’s MS-DRG target areas.
1. On the https://www.pepperresources.org/Data website, identify the current target area MS-DRGs for improper reimbursement.
2. Create a plan for monitoring these MS-DRGs. In this plan include at least:
• The types of monitoring to be performed
• Sample size to monitor
• Frequency of the monitoring
• Case selection criteria
• Documentation of monitoring activities
• A format for reporting the monitoring results
• A corrective action plan
Explanation / Answer
The larger part of references to documentation and coding depend on Medicare Severity Diagnosis Related Group (MS-DRG) inpatient forthcoming installment framework. However, for this assignment, the text will focus entirely on MS-DRG application in acute care.
We quantified consequent documentation upgrades in a fundamental, significant, and reproducible design. We develop another metric to quantify documentation, termed the "standardized case mix index," that permits examination of hospitalizations over various inconsequential MS-DRG groups ("PEPPER Resources", 2016).
Case mix complexity alludes to an interrelated yet unmistakable arrangement of patient characteristics that incorporates:
The sample size to monitor will be obtained as follows:
1050×41/100 = 430
1050-430=620
There are 1050 discharges per month; meaning 620 is the correct sample size after the adjustment has been made to the initial 1050. The sample will be monitored on a daily basis for a month.
The selection criterion relies on MS-DRG weight. The standardized MS-DRG weight compares to the commonplace doublet or triplet of related MS-DRGs. Normalizing the weight and contrasting the mean takes into consideration correlation of different MS-DRGs on a relevant premise. MS-DRG weight might be generally hard to look at for different MS-DRGs, especially while figuring out whether documentation changed at the onset of a focused on change venture (Wang, 2012).
Medical record documentation necessities ought to be tended to including:
Corrective activity may incorporate new arrangements/methods, employee control and training, and PC framework changes.
References
Kovalev, A., Naletova, D., & Belyansky, K. (2016). The current state-of-the-art of the expert evaluation of medical documentation pertaining to the cases of death from an injuryinflicted in a healthcare facility in the late; post-traumatic period. Sud.Med.Ekspert., 59(2),
PEPPER Resources. (2016). Pepperresources.org. Retrieved 14 July 2016,
Wang, C. (2012). Medical Documentation in the Electronic Era. JAMA, 308(20), 2091.