We can assist in the design and implementation of a coding compliance plan specific to your facility's needs. We identify risks in your coding practices and address these issues to reduce audit exposure. We provide 'Coding Boot Camps' with continuing education credits approved by American Health Information Management Association (AHIMA) for participating in our educational programs.  

Methods for Ensuring Coding Compliance

  • Monitor the medical record documentation in conjunction with code assignment.
  • Perform random sample monitoring on coding and data.
  • Monitor appropriateness of MS-DRG assignment.
  • Provide feedback of monitoring results.
  • Provide ongoing education.
  • Review medical record for documentation deficiencies.
  • Follow up on submitting data corrections to the fiscal intermediary.

Implementation of an Internal Auditing Process of Coding and MS-DRGs

  • Process for accurate ICD-9-CM coding and appropriate MS-DRG assignment.

Advantages of Auditing Cases Prospectively

  • Reduce billing errors.
  • Assure coding and MS-DRG accuracy.

Key Elements for Chart Review and Correct MS-DRG Assignment:

  • Ensure that the billed diagnosis is indeed the principal diagnosis.
  • The principal diagnosis must be present on admission.
  • The patient should have received evaluation or treatment for the principal diagnosis during their hospital encounter.

Advantages Of Compliance Education and Training for Coders & Physicians

  • Accurate assessment of the Severity of Illness.
  • Fully report the intensity and complexity of services provided.
  • Appropriate identification of the principal diagnosis, for which the patient was admitted and all secondary diagnoses.
  • Correct MS-DRG assignment.
  • Follow coding guidelines as outlined by the departments internal compliance with standards.
  • Assure accuracy in reported Case Mix Index (CMI).
  • Accurate internal and external encounter data.
  • Helps justify the E & M code level assigned by the physicians office.

 

 
Documentation Solutions, LLC ::: PO Box 634, Dearborn Heights, MI  48127-0634 ::: 800-419-6847