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RECOVERY STRATEGY. Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton & Associates, LLC Erin, Tennessee 37061 February 18, 2010. Pre-RAC Audits. SHIP HOSPITALS – NON-SHIP HOSPITALS Sample – 30 Records October 2007 – Present
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RECOVERY STRATEGY Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton & Associates, LLC Erin, Tennessee 37061 February 18, 2010
Pre-RAC Audits • SHIP HOSPITALS – NON-SHIP HOSPITALS • Sample – 30 Records • October 2007 – Present • Focused DRG List • Method of Selection – Selective • Focus RAC audit list • Review report utilizing All ICD-9-CM codes assigned • Length of Stay • Secondary codes assigned • Procedures performed (if applicable)
FINDINGS • Total Records: 148 • Pre-review CMI – 1.2679 • Post-review CMI – 1.3420 Total Changes – 61 • Decrease – 17 • Increase – 44 • Cumulative change/chart - .0741 • Total cumulative change – 10.9668 • Total Revenue Enhancement - $60,317.75
IMPACT • Recovery Audit Contractor (RAC) Impact • 11% of Total number of records reviewed • Weight Decrease – 6.3375 • Revenue - $34,850.00 • Total Impact • 41% of Total number of records reviewed • Total Weight Change – 17.3043 • Revenue Change - $95,200.00
UTI/SEPSIS • 690 – Kidney & urinary tract infections w/o MCC – Wt. .7708 • 700 – Other kidney & UTI infections w/o CC/MCC – Wt. .6533 • 699 – Other kidney & UTI infections w CC – Wt. .9518 • 698 – Other kidney & UTI Infections W MCC – Wt. 1.4877 • 872 – Septicemia w/o MV 96+ hrs w/o MCC – Wt. 1.1155 • 871 – Septicemia w/o MV 96+ hrs w MCC – Wt. 1.8437 • 870 – Septicemia w MV 96+ hours – Wt. 5.8007
COPDPneumonia Respiratory failure • 203 – Bronchitis & asthma w/o CC/MCC – Wt. .6055 • 202 – Bronchitis & asthma w CC/MCC – Wt. .8374 • 192 – COPD w/o CC/MCC – Wt. .7175 • 191 – COPD w CC - .9622 • 190 – COPD w MCC – 1.2076 • 195 – Simple Pneumonia & Pleurisy w/o CC/MCC – Wt. .7095 • 194 – Simple Pneumonia & Pleurisy w CC – Wt. .9976 • 193 – Simple Pneumonia & Pleurisy w MCC Wt. 1.4378 • 189 – Pulmonary edema & respiratory failure – Wt. 1.3455
COPDPneumoniaRespiratory Failure • 179 – Respiratory infections & inflammations w/o CC/MCC Wt. 1.2754 • 178 – Respiratory infections & inflammations w cc – Wt. 1.5636 • 177 – Respiratory infections & inflammations w MCC – 1.8444 • 208 – Respiratory system diagnosis w ventilator support < 96 hours – Wt. 2.2463 • 207 – Respiratory system diagnosis w ventilator support 96+ hours – Wt. 5.1231
Congestive Heart Failure • DRG 291 – Heart Failure and Shock with MCC – Wt. 1.4609 • DRG 292 – Heart Failure and Shock with CC – Wt. .9740 • DRG 293 – Heart Failure and Shock w/o CC/MCC – Wt. .6940
HomeTown Health Solution • EDUCATION • Coding Staff • Case Management/Documentation Specialty Staff • Ancillary Department Managers • Hospital Management • Physicians
Documentation Specialty Program • Develop Case Management/Documentation Specialty Program • Establish Top 10 DRG’s for facility • Develop hierarchy for Each DRG Set • Query Physicians concurrently • Make sure documentation is present before discharge • Manage LOS for Transfer DRG’S • Compare Coder DRG Assignment with Documentation Specialty DRG Assignment as an educational tool • Monitor Case Mix Index (CMI) as patterns develop
TODAY’S HOSPITAL ENVIRONMENT MANAGE IT PROVE IT
