High-Risk Medicare-Severity Diagnosis-Related Groups (MS-DRGs) You are the codin

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.

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