DRG Analysis for healthcare reimbursement

DRG Analysis for healthcare reimbursement

RG Analysis for healthcare reimbursement and revenue cycle management/medical coding

You are the Coding Manager for a mid-size acute care hospital. Based on historical data the hospital has decided to hold and review all cases that group to the following DRGs prior to claim submission:

• 192: Chronic obstructive pulmonary disease w/o CC/MCC
• 293: Heart failure and shock w/o CC/MCC
• 684: Renal failure w/o CC/MCC
• 689: Kidney and urinary tract infections w/ MCC
• 872: Septicemia w/o MV 96+ hours w/o MCC

It is your responsibility to review and present the quarterly audit results Download quarterly audit results to the HIM Director. Analyze the following audit results. Based on the audit results, address:

• Identify possible causes for incorrect DRG assignment
• Areas of concern in the revenue cycle that can affect the accuracy of DRGs
• Effect on the revenue cycle and reimbursement (individual DRG and cumulative effect – see example with the audit results)
• Provide general recommendations to improve DRG accuracy going forward
• Create a graphic display (bar chart, line graph, etc.) summarizing the audit results.

Target Course Competencies:

• Conduct activities related to revenue cycle audits.

Rubric