Improving Clinical Documentation & DRG Management Efforts

DRG Review, Inc. offers a wide range of services specifically for acute short-term care hospitals' clinical documentation improvement initiatives and their DRG management effort. These programs can be stylized to meet the needs of your facility and medical staff.

DRG MANAGEMENT

Initial MS-DRG (casemix) Assessment

A sample of inpatient health records selected based on our DRG Focus List is reviewed. These reviews are designed to assess coding accuracy, physician documentation, and the Clinical Documentation Improvement (CDI) team/physician communication process. Subsequently, it will be determined if follow-up educational sessions with the CDI team and physicians would be beneficial.

Follow-up Pre-bill MS-DRG Validation

Based on the findings of the Initial MS-DRG (casemix) Assessment, an ongoing health record review is offered electronically to provide immediate feedback of your DRG management efforts. This service will reduce the volume of your unbilled discharges as the result of our review are returned to your coding department within 48 hours.

CLINICAL DOCUMENTATION IMPROVEMENT (CDI)

Physician Staff Presentations

Following the Initial MS-DRG (case-mix) Assessment, a DRG Review, Inc. physician will address your medical staff regarding chart documentation/communication issues gleaned from the initial medical records review. The purpose of these CME-approved discussions is not to teach physicians how to code but to increase their awareness of the importance of coding and to enhance the degree of cooperation between the CDI team and physicians.

Physician CDI Training Seminar

A physician who understands the complexities of ICD-10-CM/PCS coding and the prospective payment system can often make medical determinations and communicate with the attending physician more effectively than the non-physician CDI team. Since there are few physicians proficient in inpatient ICD-10-CM/PCS coding, the prospective payment system, and DRG management, DRG Review, Inc. has developed an instructional seminar for training Physician CDI Advisors.

The items discussed during this 14-hour, CME-approved seminar includes the following:

1 The role of the physician advisor
2 The structure of the DRG system
3 Coding concepts and constraints
4 DRG validation
5 Information to enable the physician to speak with his own staff physicians regarding why physicians should be involved with DRG management. The material will also be provided to help organize newsletters and discussions with individual medical departments.
6 Sample case scenarios with examples of appropriate coding and compliance issues
7 "Hands-on" experience in accurate DRG assignment through review of actual health records

Additionally, DRG Review, Inc. offers its proprietary training manual, which will serve as a valuable reference tool as these individuals fulfill their roles as the Physician CDI Advisors.

Hospitalist Documentation Seminar

Hospital-based physicians are responsible for an increasing proportion of inpatient care. As a result, many of the hospitals’ documentation issues are impacted by this group of physicians. DRG Review, Inc. has developed a documentation program that focuses on training hospitalists.

The items discussed during the three-hour hospitalist training program include the following:

1 How physician performance profiles and payments are impacted by hospital-derived ICD-10-CM/PCS code reporting?
2 Explanation of principal diagnosis definition and selection
3 CC/MCC definitions and list
4 In-depth discussion of specific clinical items which impact the specificity of inpatient code reporting, such as syncope/underlying etiology; chest pain/CAD, ACS; types of CHF; sepsis; acute respiratory failure; AKI; Etc.
5 Discussion of how “present on admission” designation impacts physician/hospital quality and payment
6 Discussion of risk-adjusted 30-day mortality and 30-day re-admission profiling and how it is impacted by physician documentation
7 Presentation of hospital quality measures