A Description of PRC’s

Inpatient Coding Compliance and Clinical Documentation Reviews

Some of PRC's Inpatient Review Items  

  • ​Validate the Accuracy of the ICD-10-CM/PCS Diagnosis & Procedural Coding

  • Verify the Principle Diagnosis Selection and Sequencing of all ICD-10-CM codes

  • Complications and Comorbidities (CCs & MCCs) Verification

  • Validate the Accuracy of the DRG & MS-DRG Assignments

  • Provide DRG and Coding Accuracy Rates

  • Validate the Accuracy of Billing (i.e., UB-04s)

  • Validate Overall Compliance

  • Case Mix Analysis and/or Review

  • POA (Present On Admission) Validation

  • Discharge Disposition Validation

  • Admission Criteria Review

  • Analyze the Physician Query process

  • Evaluate the Clinical Documentation

  • Review Retrospective and/or Concurrent Cases

  • Remittance Advice Review

  • Re-abstract cases to indicate recommended coding changes

  • Provide Accuracy Rates and Statistics as a Group and/or at the Coder Specific Level

  • Provide Financial Impacts

  • Education (AHIMA and AAPC recognized CEU's for Coders) 

Our Inpatient Medical Records Reviews include an evaluation of your ICD‑10‑CM/PCS Diagnosis and Procedural code assignments, Complications and Comorbidities (CCs & MCCs), the Level of Clinical Documentation, Physician Querying, and the Sequencing of Codes in order to assign the appropriate DRG and/or MS-DRG.  PRC’s consulting staff has extensive experience in auditing Inpatient admissions for compliance as well as identifying opportunities to enhance DRG assignments through improving Clinical Documentation.  Therefore, PRC will not only validate the coding scheme assigned, but we will review admissions, in detail, to uncover opportunities to enhance Clinical Documentation along with DRG assignments and the Hospital’s Case Mix Index. During these projects, PRC will also review UB‑04s in order to validate the accuracy of billing claims. A comprehensive, written report will be submitted and PRC will conduct Educational sessions to present findings, and discuss recommendations.