Is your organization ready for the operational and financial impact of the proposed severity-adjusted DRG system?

(PYA Alert dated April 23, 2007)

CMS continues to plan toward transition to severity-adjusted DRGs in the near future. What will this mean for your organization and are you preparing now for this transition? Acute care organizations must appropriately capture patient acuity, as reflected in medical record documentation, starting NOW, as CMS is actively collecting data for determinations with the future system. Clear physician documentation for severity of illness translates into reimbursement better aligned with those resources utilized in providing care to the patient, as well as reporting of hospital specific clinical measures. Inclusion of all secondary diagnoses will prove critical to the organization’s success once CMS has fully retooled the current DRG system.

A focused Documentation Improvement Program promotes collaboration between Case Managers, Physicians, and HIM professionals to produce meaningful results. Case managers, typically clinicians, are uniquely positioned to champion the documentation improvement initiative. With education and training to address identified organization goals, the combined efforts across Case Management, HIM and coding professionals (who are the DRG experts), and physicians, will produce a formidable team to facilitate these efforts within your organization.

PYA’s Clinical Compliance team of Case Management and HIM professionals is prepared to assist your organization with readiness for severity-adjusted DRGs. By assessing your current Case Management and HIM coding processes, we can explore opportunities to align these departments to facilitate increased capture of clinical documentation in the medical record. Decreased denial rates, compliance with regulatory standards, and potentially improved reimbursement and case mix ratios, are key benefits derived through a successful documentation improvement program.

Please contact Lorraine Larrance or Carol Eyer at (800) 270-9629 for additional details.

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

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