(Answered)-(This is for my health care reimbursement class..I didn't know - (2025 Updated Original AI-Free Solution
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?(This is for my health care reimbursement class..I didn't know what subject to put that under since medical wasn't an option)?I need help with this- I have no idea where to even start.
The health information management team at Anywhere University Hospital (AUH) contracted with an
auditing firm to perform full assessment coding review. The results from this baseline assessment are
provided in four tables:
Variation Log by Type of Error
Variation Log by Coder
Variation Log by MS-DRG
MS-DRG Relationship Assessment
You are the inpatient coding manager at AUH. Your director has asked you to develop an ongoing
review and monitoring schedule for the next year based on the results from the outside review.
Include internal and external reviews, coding in-services, physician workshops, and external
seminars/educational sessions that will be performed and or provided for your staff. The schedule should
be specific (include volumes and/or percentages of charts to be reviewed). Keep in mind that on average
it takes 18 minutes to review one inpatient chart. Budget provides for $65,000 for external reviews. The
average cost for reviewing one inpatient record by an external review team is $55.00 (fully loaded).
In addition to preparing the schedule, outline how you will maintain coding quality statistics and
report them back to the HIM Director and Compliance Committee at your facility.
How will you reward your staff members who show great improvements?
How will you reward and/or recognize that your staff has made improvements overall?
Your Coding Team consists of:
Coding Manager (you)
1-Data Quality Auditor (1 FTE)
8-Inpatient Coders (8 FTE)
2-RHIA, CCS
3-CCS
3-RHIT
Results of the full assessment coding review for AUH:
Two audits were performed:
1. Coding quality review by MS-DRG
2. MS-DRG Relationship Analysis
Variation Log by Type of Error
Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG
Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG
Omission CC, affect MS-DRG
Omission CC, non affect MS-DRG
Inaccurate principal procedure, affect MS-DRG
Omission procedure, affect MS-DRG
More specific coding of diagnosis or procedure, non affect MS-DRG
Inaccurate coding
Missed diagnosis or procedure code
Coder
Coder 1
Coder 2
Variation Log by Coder
Error Rate
3%
9%
% of errors
17%
16%
33%
2%
3%
4%
12%
5%
8%
Standard
5%
5%
Coder 3
Coder 4
Coder 5
Coder 6
Coder 7
Coder 8
8%
2%
4%
16%
12%
3%
5%
5%
5%
5%
5%
5%
Variation Log by MS-DRG*
MS-DRG
Volume
Error
Rate
470
420
2%
313
233
14%
392
232
1%
291
232
17%
247
220
3%
292
216
5%
871
213
12%
641
209
0%
194
195
3%
293
193
1%
885
188
3%
312
177
0%
191
175
7%
287
173
2%
310
171
15%
689
157
11%
603
143
2%
379
137
3%
192
131
9%
683
116
11%
189
114
1%
069
110
2%
190
92
12%
193
87
10%
690
76
4%
065
76
5%
195
72
2%
066
52
2%
064
41
5%
906
35
2%
*MS-DRG descriptions provided below
Variation Log by MS-DRG* Set
MS-DRG Set
Hospital %
Nation %
064
24.3%
21.4%
065
45.0%
43.8%
066
30.8%
34.8%
190
191
192
23.1%
44.0%
32.9%
15.2%
33.5%
51.3%
193
194
195
24.6%
55.1%
20.3%
17.5%
54.2%
28.3%
291
292
293
34.6%
36.7%
28.8%
29.2%
38.8%
31.9%
689
67.4%
21.7%
690
32.6%
78.3%
*MS-DRG descriptions provided below
MS-DRG
064
065
066
069
189
190
191
192
193
194
195
247
287
291
292
293
310
312
313
379
392
470
603
641
683
MS-DRG Title (FY 2008)
Intracranial hemorrhage or cerebral infarction w MCC
Intracranial hemorrhage or cerebral infarction w CC
Intracranial hemorrhage or cerebral infarction w/o CC/MCC
Transient ischemia
Pulmonary edema & respiratory failure
Chronic obstructive pulmonary disease w MCC
Chronic obstructive pulmonary disease w CC
Chronic obstructive pulmonary disease w/o CC/MCC
Simple pneumonia & pleurisy w MCC
Simple pneumonia & pleurisy w CC
Simple pneumonia & pleurisy w/o CC/MCC
Perc cardiovasc proc w drug-eluting stent w/o MCC
Circulatory disorders except AMI, w card cath w/o MCC
Heart failure & shock w MCC
Heart failure & shock w CC
Heart failure & shock w/o CC/MCC
Cardiac arrhythmia & conduction disorders w/o CC/MCC
Syncope & collapse
Chest pain
G.I. hemorrhage w/o CC/MCC
Esophagitis, gastroent & misc digest disorders w/o MCC
Major joint replacement or reattachment of lower extremity w/o MCC
Cellulitis w/o MCC
Nutritional & misc metabolic disorders w/o MCC
Renal failure w CC
689
690
871
885
906
Kidney & urinary tract infections w/ MCC
Kidney & urinary tract infections w/o MCC
Septicemia w/o MV 96+ hours w MCC
Psychoses
Hand procedures for injuries
Submit the following question to think about as you design this:
Who will be responsible for providing education regarding coding issues?
Who will be responsible for arranging clinical education sessions?
Who will audit charts?
Who will answer coding questions for the coders?
Who will monitor coding improvement and provide progressive discipline
when required?
Note: The more administrative duties given to the data quality auditor,
the fewer number of charts he or she can review on a daily basis.
Please also include the following:
1. A schedule that optimally utilizes the data quality auditor?s position before
scheduling external reviews that have an additional cost. The data quality auditor?s
review schedule should be designed not to delay the completion of accounts for
billing. If the DQA has piles of charts to review, then the bills are not being released
for payment. The workflow must be logical.
2. There should be at least one education session per month. The month of September
should include an in-service for ICD-9-CM updates, and December should include
an in-service for CPT/HCPCS updates. Keep in mind that scheduling too many
sessions per month may negatively affect productivity.
Educational topics should be related to clinical areas where there was significant
MS-DRG coding variation [Respiratory, Cardiology and Vascular Services].
Educational topics should relate to coding areas identified in the Variation Log by
Type of Error including:
A. Correct coding of major complications and comorbidities and complications
and comorbidities
i. This is again emphasized in the MS-DRG relationship assessment
where several pairs of with and without MCC/CC MS-DRGs are
reported at a higher rate at the hospital than in the state.
B. Correct sequencing of diagnoses
C. Specificity of codes
i. A conversation regarding documentation issues may be warranted
here.
3. Be CREATIVE!
Reporting coding quality statistics:
1. How are you going to maintain the coding quality statistics? I
Rewards, etc.
1. How are you going to reward your team, think about what incentives you appreciate
at your current position or a previous position.