Hospitals typically audit coding to make sure it is accurate, complete and compliant with national correct coding guidelines. Audits are usually retrospective and often focus on high volume diagnoses, procedures or diagnosis-related groups (DRGs). Audits may also include a random sample of inpatient and outpatient coding.
Coding audits are a valuable tool for educating coders and improving coding quality and compliance. However, the sample sizes are frequently insufficient to identify problematic patterns that result in lost revenue.
JTS analytical services include:
Target specific areas of MS-DRG’s to assess the extent to which revenue is lost to incomplete or inaccurate coding.
Target trends of data for facilities comparing their MS-DRG rates to established Centers for Medicare & Medicaid Services (CMS) MS-DRG benchmarks. Based on outcomes, accounts are reviewed to determine if deviations from the national mean are due to incorrect MS-DRG assignment or are supported by documentation. The CC/MCC Capture Rate of a facility is a good indicator to determine if a facility is overreporting or underreporting CCs or MCCs within a MS-DRG pair or triplet.
JTS then works with key organizational stakeholders to create the following: