MS-DRG & Case Mix Index Review

Developed to provide the Client with information obtained through medical record review and CMI analysis that is pertinent to developing a process to improve Health Information Management (HIM) coding staff understanding of the relationship between MS-DRG and ICD-9-CM sequencing, which will enhance overall coding techniques. 

The scope of the engagement includes an on-site review of inpatient records and case mix index report. The inpatient records and corresponding claims are reviewed for:

• ICD-9-CM assignment, following guidelines published in the AHA's Coding Clinic for ICD-9-CM 
• MS-DRG assignment through appropriate sequencing of principal and secondary diagnosis(es) 
• Supporting diagnosis(es) for medical necessity of services performed, e.g., laboratory tests, X-rays, procedures, medications, etc. 
• Supporting documentation for covered services not captured 
• Appropriate signatures and dates on orders and notes as required

The CMI summary report is reviewed to: 

• Evaluate top volume MS-DRGs 
• Physician's discharges are reviewed against like specialists' to evaluate any patterns of increased length of stay and over-utilization of hospital resources

Value Added Benefits for this Service:

• More knowledgeable staff 
• Enhanced coding techniques 
• Open dialogue between coders and physicians

Added Feature:

• Coding and Billing Helpline provided at no additional cost during the term of the contract. Client's staff may take advantage of this helpful service to answer questions arising from coding and billing issues.