Inpatient Coding/DRG compliance reviews are performed on-site to validate the medical record coding/DRGs and assess the quality of supporting documentation for an appropriate sample of patient records. All coding changes, regardless of the resulting impact on the DRG assignment, are flagged. For each recommended coding/DRG change, there will be provided written justification, including references from Coding Clinic and citations and markings of supported documents in the patient record. St. Clair will conduct an exit conference, with HIM Management and Hospital Management representatives, regarding preliminary review findings and recommendations. St. Clair will also do an educational in-service discussion with HIM coders on "coding change/documentation" findings. This discussion qualifies for one (1) continuing education (CE) credit under CE requirements of AHIMA. Within two (2) weeks after the on-site visit, a detailed final report is provided.
Coding risk areas, identified by the Office of the Inspector General and CMS, are checked. Feedback is provided to the hospital customer with regard to the integrity of the coding and DRG assignments, and the quality of the chart clinical documentation. We will make recommendations on how to improve performance in these areas if needed and assist with implementation. Reviewed medical records are from 30-90 days after discharge so that the hospital customer has the option to re-bill Medicare for any of our recommended Coding/DRG changes without the requirement of additional chart documentation by the fiscal intermediary. For one (1) year after the review, at no additional fee, St. Clair provides consultant support, via telephone and/or email, to address any questions about the final report and/or inpatient coding regulatory changes.
The St Clair professional fee for on-site inpatient coding/DRG reviews is competitively priced on a per record reviewed basis, plus travel expenses.