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DETAILED DESCRIPTION OF AN INPATIENT
MEDICAL RECORDS REVIEW
Our Inpatient Medical Records Review focuses on compliance with all Government regulations, and includes accuracy and reimbursement issues as well. This Review encompasses ICD-9-CM codes Diagnosis and Procedure codes, Complications and Comorbidities (CCs), POA indicators, and DRG/MS-DRG assignments. During the project, we will also review UB-04s in order to validate the accuracy of billing claims. While conducting the on-site Review, we will evaluate the level and completeness of the documentation, and provide an educational session for your staff and/or physicians; CE credits may be awarded by their professional organizations for attending. A resolution session will be held at the end of the on-site project, where all of our findings, errors, and discrepancies will be discussed, and our initial recommendations will be made. A comprehensive, written report will be submitted in a timely manner. A few of the key items in our specialized Inpatient Reviews are:
Focus on Compliance
ICD-9-CM Code Verification
DRG & MS-DRG Validation
Complications and Comorbidities (CCs & MCCs) Verification
POA (Present On Admission) Validation
Discharge Disposition Validation
MAJOR
OBJECTIVES OF AN INPATIENT MEDICAL RECORDS
REVIEW
Provide DRG and Coding Accuracy Rates
Validate the Accuracy of the ICD-9-CM Codes
Verfiy the Principle Diagnosis Selection and Sequencing of all other ICD-9-CM codes
Complications and Comorbidities (CCs & MCCs) Verification
Validate the Accuracy of the Documentation
Validate the Accuracy of the DRG & MS-DRG Assignments
Validate the Accuracy of Billing
Validate Compliance
Case Mix Analysis and/or Review
POA (Present On Admission) Validation
Discharge Disposition Validation
Admission Criteria
Provide Education
Analize the Physician Query process
Identify Documentation Concerns
KEY ELEMENTS
OF AN INPATIENT MEDICAL RECORDS REVIEW
Compliance Focus
Review Retrospective and/or Concurrent Cases
ICD-9-CM Codes
. Diagnosis
. Procedure
Complications and Comorbidities (CCs & MCCs)
Case Mix Analysis and/or Review
DRG & MS-DRG Assignments
POA (Present On Admission) Criteria
Clinical Documentation Improvement
Reimbursement Impact
UB-04 Review
Remittance Advice Review
Physician Query Appropriateness
Re-abstract cases to indicate recommended coding changes
Education (AHIMA and AAPC recognized CE's for coders)
Opening Meeting
. Resolution Session
. Comprehensive Final Report
