Certified coding professionals will perform a review of coded data and medical record documentation to identify and assess areas of risk related to compliance and specifically those areas identified by the OIG's workplan. Specific areas include:
- Appropriate assessment of ICD-9-CM principal and secondary codes
- Appropriate assignment of procedure codes
- Appropriate sequencing
- Appropriate application of coding guidelines
- Appropriate assignment of the MS-DRG
- Appropriate discharge disposition status code
- Appropriate present on admission (POA) indicator
Additional features:
Identify appropriate reimbursement adjusting under or over coding
Identify potential complication/comorbidity(CC) and/or major CC opportunities
Identify potential MD queries related to severity
Provide a statistical breakdown of coding errors (up and down)
Identify official coding guidelines applicable to the findings and develop focused educational efforts
Identify potential opportunities for the Concurrent Documentation Program (CDP)
Educate medical staff
The primary benefits are to augment on-going compliance processes and establish a foundation for operational improvements.
