Inpatient coding/DRG compliance reviews for "prospectively paid" inpatients are performed, off-site, on an ongoing basis using faxed excerpts of medical records. For each reviewed patient, there is prepared a report of the findings, including written justification for each recommended medical record coding/DRG change, with 24 hour turn-around via fax. Of course, our recommended inpatient coding/DRG changes are subject to review and approval by the HIM Department and the attending physicians.
In conjuncture with such off-site reviews, St. Clair offers the option of having one of our physician consultants visit your hospital on a periodic basis to perform a focused review of recent discharges, conduct coding educational sessions for the HIM Coding Staff and meet with the Medical Staff to discuss the importance of documenting the clinical care of the patients in their chart assessments.
The hospital customer is provided with assurance as to the integrity of the coding and DRG assignments, as well as feedback as to the quality of the chart clinical documentation. We will make recommendations for how to improve performance in those areas, if needed, and assist with their implementation. The cases are reviewed before billing, so that the hospital customer has the option of incorporating any accepted coding/DRG change recommendations to the initial third party billing. This ongoing review approach prevents lost revenue due to inaccurate coding.
The St Clair professional fee for an off-site review is competitively priced on a "per record" reviewed basis. The St Clair fee for the on-site educational sessions is priced on a "per-day" basis, plus our of pocket travel expenses.