DRG (DIAGNOSIS RELATED GROUP) REVIEW
YPRO consultants review inpatient records for appropriate DRG assignment based on guidelines established by payer policy guidelines and coding guidelines as established by Coding Clinic and CPT Assistant.
PURPOSE
A DRG review can assist facilities with the following:
1. Identify if facility is accurately capturing clinical documentation
2. Identify if facility is accurate coding and selecting principal diagnosis
3. Identify accuracy of coding all primary and secondary procedures
4. Identify accuracy of coding Complications and Co-morbidities
5. Identify accuracy of discharge disposition assignment
6. Identify accuracy of DRG assignment
7. Identify overpayments and underpayments
8. Provide expert knowledge to areas requiring Intensive Education
METHODOLGY
DRG review can be done on a pre-bill or post-bill basis and on-site or off-site using YPRO Corporation's ImageCode.
On the pre-bill basis, the YPRO consultant works with your coding staff, nurse manager and physician on all current medical records. A pre-bill review identifies documentation issues, coding changes, complications, co-morbidities and sequencing changes that can be discussed with the physician or case manager while the patient is still in house. These changes may result in more accurate quality ratings/rankings, more accurate coding, more accurate reimbursement, less risk liability, less denials and better cash flow.
On the post-bill basis, the YPRO consultant reviews those medical records for DRG review which are selected utilizing Office of the Inspector General (OIG) current work plan along with YPRO's DRG's identified for intensive education or as directed by client. Remittance advices from the previous 60 days are utilized to select these DRG's, as all corrections from these cases can be resubmitted based upon coding guidelines. The benefits of a post-bill DRG review are similar to the pre-bill review; more accurate quality ratings/rankings, more accurate coding, more accurate reimbursement, and less risk liability.
Both types of reviews provide education for your coding staff. The findings from the review are complied into a summary report that is given orally to your staff, allowing them the opportunity to ask questions and get feedback. 1 CE unit can be earned by those attending the oral summary report. The client is also provided with a detailed written report for compliance documentation requirements.
BENEFITS:
· Improve coding accuracy
· Improve DRG assignment
· Improve quality ratings/rankings
· Improve reimbursement
· Decrease denials
· Decrease risk liabilities
· Improve adherence to compliance regulations
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