| Hospital
Inpatient DRG Audits
The
purpose of DRG audits is to assess the accuracy of ICD-9-CM diagnosis
and procedure codes. To put your attention where it's needed most,
audit findings focus on significant discrepancies which impact on
DRG assignment and payment. All coding changes suggested are backed
up by citations from the medical record and reliable, definitive
sources for coding guidelines. Audits can be scheduled on a regular,
recurring basis or as a one-time review.
The
DRG Audit Process
Sample
Selection : Sample selection varies depending on
your preference. You may select all cases or leave the selection
to Clarity Coding. A combination approach may also be used. Although
troublesome cases may be one focus in the selection, a random element
should always be a feature of the case selection.
Case
Review : For each case selected, we identify and
review the accuracy of the data used to assign the current DRG including:
• selection of the principal diagnosis
• ICD-9-CM codes assigned to all significant diagnoses and
procedures
• clinical documentation
• demographic data including patient age and discharge status
Finalization
: Finalization takes place shortly after case review.
Hopsital representatives review the preliminary findings to determine
if they agree or disagree. Initial disagreements are discussed with
the specialist until mutual agreement is reached.
Results
are then formalized, including a listing of all DRG changes and
impact on payment as well as recommendations for changes in coding
practice.
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