Typically, hospitals utilize validation services retrospectively to evaluate inpatient cases after claims have been submitted and payment decisions determined. Incorrect DRG coding assignments realized after time-of-care prevent proper reimbursement for services rendered, most often resulting in underpayments.
Resonant Physician Advisory services, a Tacoma, Wash.-based physician advisory firm, and Sandra Routhier, RAC reporter, suggest five areas to examine within hospital admissions for DRG improvement opportunities:
1. Physician documentation accuracy and completeness
2. Coding education and guidelines (i.e. adherence to coding guidelines, knowledge of disease processes or surgical techniques)
3. EMRs (i.e. identifying revisions needed to templates, canned text, problem lists)
4. Medical system workflows (system issues related to the flow of data from registration to coding/abstracting to billing systems)
5. Lead physician and care team collaboration in documentation improvement
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