Pre-bill MS-DRG monitoring is an essential part of the development of a long term sustainable and effective Clinical Documentation Improvement Program. It identifies educational opportunities for all parties involved in the clinical documentation/coding process and is a vital component of all of our services. Additionally, it assures there is no loss of opportunities for improving payment and, equally important, that compliance errors are addressed before billing. Our 24-hour pre-bill review includes daily interaction and recommendations based on the review of both the clinical coding analysts and physicians. A MS-DRG focus list and detailed summary reports identifying financial impact are provided monthly.

Initial Coding Assessment and Staff Education 

Our approach is to begin with a 30-day Risk Free Initial Assessment of your current level of MS-DRG  Management.  This service is provided by offsite, online reviews of the electronic medical record of select DRGs after coding and prior to billing. The select DRGs are based on a focus list that is an analysis of your DRG volumes and distributions.

Fee for all services provided during this period will be generated from the added revenues realized from our chart reviews. Over the last three years the rate of return on investment observed for the 30-day reviews has ranged from 300% to 1100%.

The purpose of this 30-day assessment is to gauge the following:

  • Potential impact on case mix index/financial returns with a fully implemented MS-DRG management program
  • Educational needs of your coding staff
  • Quality and efficiency of your physician query process
  • Documentation issues of the medical staff
  • Current level of physician cooperation in the MS-DRG management process
  • The need for CDI implementation or assessment of the existing program
  • A two-hour AHIMA CE-approved exit review by one of our staff physicians, will be provided for the coders and documentation specialists at the conclusion of the assessment.

 

Daily Pre-Bill MS-DRG Assurance Monitoring 

Although we have found the initial phase to have a beneficial impact on the physician’s documentation effort, it is often necessary to provide daily remote chart reviews to help monitor the physician’s documentation effort and continue the education of the coding staff on issues delineated with the initial audit.

  • MS-DRG validation reviews based on an MS-DRG focus list based on facility outcomes
  • 24 hour turnaround time on all reviews to minimize the impact on the DNFB
  • Detailed summary report provided each month with statistical and financial impact of review
  • Staff availability for discussion on all recommendations
  • Improved facility coder education and enhanced physician communication through effective and compliant physician queries
  • On-site or webinar education by one of our physicians to address coding related issues
  • Defend any recommendation if challenged by a third party payer at no extra cost through the appeal process

 

We also provide retrospective Compliance Quality Audits. This service involves an initial online analysis of the client’s inpatient ICD-9-CM data interfaced with our proprietary software methodology to identify areas of risk for coding compliance. The software analysis comprises extensive data edits segregated by ICD-9-CM diagnosis codes, procedure codes, and related MS-DRGs. Medical records are then selected from the initial analysis and are reviewed post-discharge by our physicians and clinical coding analysts to facilitate accurate coding, thereby reducing the risk of an adverse determination from external regulatory reviewers. A detailed risk assessment summary report is provided.

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