Part 3 – Look at the two 3M screenshots, evaluate for discrepancies in the DRG’s, MCC’s, and Relative Weights. Using the readings from this week, your independent research, and the Assignment Rubric, develop a well-thought-out response to the following statement:
- Determine what discrepancies exist and interpret how they affect the Revenue Cycle Management Process. Your response should be made in 2-3 well-constructed paragraphs.
Part 4 –As you identified in Week 3, after reviewing the two screenshots from the 3M encoder, Mary Smith, RHIT, Inpatient Coder for Davenport Hospital was coding Acute Respiratory Failure as a secondary diagnosis when the attending physician did not confirm it. You were able to determine that there is a significant increase in the DRG payment when Acute Respiratory Failure is coded because it adds an MCC to the pneumonia DRG.
Because of this finding and the fact that the DRG of 193, Simple Pneumonia with MCC was the DRG with the large increase in the Case Mix index from the previous year that raised a red flag with the CFO, an external audit was launched on all charts coded with the DRG of 193. The findings were consistent in the fact that the coder was miscoding respiratory failure. Out of 47 charts coded in the previous 6 months with the DRG of 193, only 14 of them had supporting documentation. The 33 charts that were coded incorrectly happened to be patients of Dr. Black and were coded by Mary Smith.
Part 4 – Using the Assignment Rubric, focus on the findings and how you will report the outcomes for quality management purposes to the Compliance Committee.
- Create a PowerPoint Presentation with a minimum of 5 slides including content that highlights the issue, the initial findings, the result of the audit, and outcomes reporting for quality to present to the facility and Committee.
Part 5 –Part 5 – From the quality report (PP presentation) in week 5, you will develop a performance improvement plan. After carefully reviewing all of the data presented in the Ethical Coding Scenario from Weeks 2-5, you will now research and develop a written performance improvement plan for both documentation and coding that you will present to the Compliance Committee. Be sure to include the issues with Dr. Black’s documentation and Mary Smith’s coding quality. Use the Assignment Rubric as a guide. Must be a minimum of two pages in APA format.
