Inpatient Coding/MS-DRG Review by Physician Consultant

Process

Pre-billing inpatient coding/MS-DRG compliance reviews for Medicare inpatients are performed, off-site by St. Clair Physician Consultant, on an ongoing basis using excerpts of medical records which are accessed by the client’s electronic medical record system or via their being faxed. For each reviewed patient, St. Clair prepares a report of the findings, including written justification for the recommended coding/MS-DRG change, with 24 hour turn-around via email or fax. Of course, each of our recommended inpatient coding/MS-DRG changes is subject to review and approval by the Health Information Management (HIM) Department and the responsible attending physician. The St. Clair Physician Consultant is available and responds immediately by telephone to questions, on a recommended coding/MS-DRG change, from coding staff and/or an attending physician.

In a monthly educational in-service with the HIM coders/management via a conference call, a St. Clair Physician Consultant will discuss the recommended coding/MS-DRG changes in selected cases from those reviewed monthly. This discussion will include what to look for in the record, regarding past medical history, presenting symptoms, daily test results, progress notes, and procedures, that may change the primary/secondary diagnoses, the diagnoses sequencing, and/or the procedures.

Benefit

A hospital is assured as to the accuracy of the inpatient coding/MS-DRG assignments, as well as feedback as to the quality of the record clinical documentation. The inpatient cases are reviewed after the coding/MS-DRG assignment has been completed by the HIM Department and prior to billing Medicare.  Thus, a hospital has the option of incorporating any accepted coding/MS-DRG change recommendations into its original Medicare billing.

Pricing Approach

The St. Clair professional fee for an off-site inpatient coding/MS-DRG review by our Physician Consultant is competitively priced per case reviewed.