medicare’s proposed ms-drgs: a coding perspective
TRANSCRIPT
© Copyright 2007 American Health Information Management Association. All rights reserved.
Medicare’s Proposed MS-DRGs:
A Coding Perspective
Audio Seminar/Webinar June 26, 2007
Practical Tools for Seminar Learning
Disclaimer
AHIMA 2007 Audio Seminar Series i
The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. CPT® five digit codes, nomenclature, and other data are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. As a provider of continuing education, the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.
Faculty
AHIMA 2007 Audio Seminar Series ii
Gloryanne Bryant, BS, RHIA, CCS
Ms. Bryant has over 27 years of experience in the health information management profession. Gloryanne currently is the Corporate Director of Coding/HIM Compliance for Catholic Healthcare West (CHW), located in San Francisco, California. In this role, Gloryanne has responsibility for the coding and documentation compliance of 40 acute care facilities and a variety of other non-hospital based healthcare entities (outpatient settings) in three states. Gloryanne has the charge of developing, implementing/setting and maintaining System Wide coding policies, and creating an internal coding compliance auditing and monitoring team and process. She is also responsible for maintaining on-going continuing education to the CHW coding and charging staff, and providing specific documentation related education to physicians, case management, and other ancillary clinicians. In addition, she works closely with Senior Management and those involved with the CDM (Charge Description Master) and are a driving-force for regulatory updates and communication.
Gloryanne serves as a volunteer leader for the California Health Information Association (CHIA) as a Director to the state board and has served several national positions for AHIMA (American Health Information Management Association). Gloryanne has served as a Director and Past-Chair for the Society for Clinical Coding (SCC), and served two years on the AHIMA Compliance Task Force. As a Health Information Management Practitioner in the HIM/Coding arena, she was on the AHA Editorial Advisory Board (EAB) on ICD-9-CM for Coding Clinic for two years and completed serving a three- year term on the Council on Accreditation for AHIMA. She continues to publish articles and agrees to be interviewed for national publications like “For the Record”, “Medical Record Briefing”, “CHIA Journal”, “AHIMA Journal” and “Advance” magazines for HIM.
In June 2000, Gloryanne received the “CHIA Literary Award”, from the California Health Information Association (CHIA) for her many articles and writings related to clinical documentation improvement, compliance, data quality and coding and in 2003 she received the CHIA award for “Distinguished Member”. In August 2005, Gloryanne was appointed to the HHS CMS (Centers for Medicare and Medicaid Services) APC Advisory Panel to work on OPPS policy, coding and reimbursement issues. She was recently (11/06) appointed to the RAND Technical Expert Panel on Severity DRGs. Gloryanne is a sought-after national speaker and author on healthcare compliance, reimbursement, clinical documentation, coding regulations (ICD-9-CM and CPT) and serves as a catalyst for change and improvement in healthcare
Gail Garrett, RHIT, CCS
Gail Garrett is a RHIT and serves as the Assistant Vice President in the Regulatory Compliance Department supporting Coding Compliance for a large healthcare organization. Her staff responsibilities include company-wide program development and application in the areas of coding compliance for hospitals, ambulatory surgery centers, imaging centers, and physician practices.
Gail is an active volunteer for AHIMA and is currently the Co-Chair of AHIMA’s Clinical Terminology/ Classification Practice. She has authored a practice brief and presented a seminar on the UB-04 and is active in many areas
Table of Contents
AHIMA 2007 Audio Seminar Series
Disclaimer ..................................................................................................................... i Faculty .........................................................................................................................ii Agenda ................................................................................................................... 1 Proposed IPPS ............................................................................................................... 2 Medicare Severity Diagnosis Related Group ...................................................................... 3
Examples.............................................................................................................. 5 Polling Question #1............................................................................................... 8
Complication/Comorbidity List ......................................................................................... 8 Examples.............................................................................................................12
Behavioral Adjustment...................................................................................................14 Maryland Example................................................................................................15 Coding Improvement............................................................................................16
Changes to Specific DRGs ..............................................................................................17 Hospital Acquired Conditions, Including Infections ...........................................................19 Present on Admission ....................................................................................................19
“Never Events” – IPPS and POA Impact..................................................................20 2 or more conditions ............................................................................................20 New Legal Ramifications .......................................................................................21 Indicator Definitions .............................................................................................22 CMS Transmittal 1240...........................................................................................23 Deficit Reduction Act 2005 ....................................................................................23 What Will Happen in October 2008?.......................................................................24 POA Examples .....................................................................................................24 Polling Question #2..............................................................................................25
Preparing for IPPS Changes Don’t be Encoder Dependent.................................................................................27 Next Steps...........................................................................................................27 Action Steps ........................................................................................................28 Clinical Documentation Improvement ............................................................30 Specifically for POA......................................................................................31
Summary ..................................................................................................................32 References and Resources .............................................................................................33 Audience Questions Appendix ..................................................................................................................37 CE Certificate Instructions
Proposed MS-DRGs: A Coding Perspective
AHIMA 2007 Audio Seminar Series 1
Notes/Comments/Questions
Agenda
• Proposed FY 2008 DRG methodology change• Overview of MS-DRGs• Specific DRG changes• Discussion of revised
complication/comorbidity (cc)
• Highlight other IPPS proposed changes• Discussion of POA (Present on Admission)• HIM Coding - Action Steps to take to
prepare for Proposed Changes• Question and Answer Session
1
Proposed Inpatient Prospective Payment System (IPPS)
2
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
3
Comments were due 6/12/07Final rule expected on or about 8/1/07
Proposed IPPSLast year’s proposed rule (CSA-DRGs)
CMS contracted with RAND corporation3M/HIS• CMS DRGs modified for AP-DRG Logic• Consolidated Severity Adjusted DRGs
Health systems consultants• Refined DRGs
HSS/Ingenix • All Payer Severity DRGs with Medicare modifications
Solucient• Solucient Refined DRGs
RAND interim reportFinal report expected by September
4
Proposed MS-DRGs: A Coding Perspective
AHIMA 2007 Audio Seminar Series 3
Notes/Comments/Questions
Proposed IPPS
Proposed rules states that adoption of MS-DRGs for FY08 would not prohibit CMS from adopting another severity-adjusted prospective payment system
5
Medicare Severity Diagnosis Related Group (MS DRG)
6
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
MS-DRGs
CMS proposing 745 new Medicare-Severity DRGs (MS-DRGs) to replace current 538 CMS DRGs• Based on current CMS DRG• Greatly improves CMS’ ability to identify groups
of patients with varying levels of severity using secondary diagnoses
• Does a better job of identifying technology• Represent comprehensive approach to applying
severity of illness stratification for Medicare patients throughout the DRGs
7
Creating MS-DRGs
Consolidate CMS DRG
In many cases, subdivide each base DRG into subclasses based on CCs
However, not in all cases
8
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Creating a MS-DRG
Created up to three tiers of payment for each DRG based on the presence of: a major complication or comorbidity (MCC), a complication or comorbidity, or no complication or comorbidity
9
Current DRG
DRG 89 Simple Pneumonia, > age 17, with cc
DRG 90 Simple Pneumonia, > age 17, without cc
DRG 91 Simple Pneumonia, age 0-17
Proposed MS-DRG
DRG 193 Simple Pneumonia with MCC
DRG 194 Simple Pneumonia with CC
DRG 195 Simple Pneumonia without MCC or CC
Example of Current CMS and Proposed MS-DRG (Impact Coding)
10
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Current DRG
DRG 79 Respiratory Infection and Inflammation, > age 17, with cc
DRG 80 Respiratory Infection and Inflammation, > age 17, without cc
DRG 81 Respiratory Infection and Inflammation, age 0-17
Proposed MS-DRG
DRG 177 Respiratory Infection and Inflammation with MCC
DRG 178 Respiratory Infection and Inflammation with CC
DRG 179 Respiratory Infection and Inflammation without
MCC or CC
Example of Current CMS and Proposed MS-DRG (Impact Coding)
11
Example of Current CMS and Proposed MS-DRG (Impact Coding)
Current DRG
DRG 291 Heart Failure and Shock with MCC
DRG 292 Heart Failure and Shock with CC
DRG 293 Heart Failure and Shock without MCC or CC
Proposed MS-DRG
DRG 127 Heart Failure and Shock
12
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Example of Current CMS and Proposed MS-DRG (Impact Coding)
Current DRG
DRG 313 Chest Pain
Proposed MS-DRG
DRG 143 Chest Pain
13
Current DRG
DRG 246 Perc cardiovascular proc w/ drug-eluting stent w/ MCC
DRG 247 Perc cardiovascular proc w/ drug-eluting stent w/o MCC
Proposed MS-DRG
DRG 557 Perc Cardiovascular Proc with drug-eluting stent with MCV dx
DRG 558 Perc Cardiovascular Proc with drug-eluting stent without MCV dx
Example of Current CMS and Proposed MS-DRG (Impact Coding)
14
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Polling Question #1
Has your facility conducted an analysis of MS-DRGs?
*1 Yes*2 No*3 Don’t Know
15
Complication/Comorbidity List
16
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Definition for Reporting/Documenting Secondary or Other Diagnosis
Conditions that affected patient care in terms of requiring:
• clinical evaluation; or• therapeutic treatment; or• diagnostic procedures; or• extended the length of
stay; or• increased nursing care
and/or monitoring
Document all conditions/diagnoses
Proprietary business document. Do not copy or distribute outside of CHW System without the expressed written permission of CHW Corporate Coding/HIM Compliance Department. Dev 12/02
Also: Coding guidelines state “… all conditions that coexist at the of admission, that develops subsequently, or that affect the treatment received and/or the length
of stay. Diagnoses that relate to an earlier episode which have no bearing on
the current hospital stay are to be excluded”
17
Complications and Comorbidities
The presence or absence of a comorbid/complication or “CC” can have an impact on the DRG assignmentDefinition:• A condition (pre-existing or arises during the
stay) that prolongs the length of stay by at least one day in approximately 75 percent of the cases.
Physician documentation is essential to capture patient comorbid/complications• Resource consumption
18
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Revised CC list (Impact Coding)
Revised CC list• Intensive monitoring; expensive and
technically complex services or extensive care involving multiple caregivers
• Significant acute manifestation of the disease or an advanced stage or chronic diseases associated with extensive debility
Physician Documentation continues to be key 19
Changes to the “CC List”(Impact Coding)
Proposed CC list is comprised of significant acute diseases, acute exacerbation of significant chronic diseases, advanced or end-stage chronic diseases and chronic diseases associated with extensive debilityCMS reviewed 13,549 secondary diagnosis codes to evaluate their assignment as a CC or non-CC using a combination of mathematical data and the judgment of its medical officers• The removal of many common secondary
diagnoses 20
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Categorization of CC Codes
13,549Total
8,232Non-CC
4,221CC
1,096MCC
Number of Codes
Per CMS this change reduced “cc” capture rate from 77.66% to 40.34%
21
Currently …….
IF IT’S NOT DOCUMENTED, WE CANNOT CODE IT!
Acidosis Epilepsy Pathological Fractures Alcoholism Hematemesis Phlebitis Anemia due to blood loss Hematuria Pleural Effusion Angina Hypernatremia Pneumonia Atelectasis Hyponatremia Pneumothorax Atrial Fibrillation Ileus Renal Failure (acute/chronic) Atrial Flutter Malnutrition Renal Insufficiency (acute/chronic) Cachexia Melena Thrombophlebitis Convulsions Metastasis (specify site) Urinary Obstruction CHF Pancreatitis Urinary Retention COPD Paroxysmal Supraventricular Urinary Tract Infection Decubitus Ulcers Tachycardia Ventricular Fibrillation Dehydration Paroxysmal Ventricular Ventricular Flutter Diabetes, out of control Tachycardia Drug Use, Abuse, Dependency
Proprietary business document. Do not copy or distribute outside of CHW System without the expressed written permission of CHW Corporate Coding HIM Compliance Department. Dev. 10/03, Rev 10/05
Thank you for your help!
22
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Examples of Major Complications/Comorbidities (MCC)
Sepsis
Acute MI
Acute/chronic diastolic/systolic heart failure
Cardiac arrest
Pneumonia
Acute respiratory failure
23
Examples of Complications/Comorbidities (CC)
Unstable angina
Htn Heart disease with heart failure and/or renal failure
Acute exacerbation of chronic bronchitis
Acute cystitis/UTI
Cardiac arrest
Ileus
CVA
24
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Special Consideration for Certain MCC or CC
(complete listing of impacted diagnoses)
Ventricular fibrillation
Cardiac arrest,
Cardiogenic shock,
Other shock without mention of trauma
Respiratory arrest
Excluded as MCC/CC if the patient expires during the admission 25
Proposed Former non-CC to CC or MCC
Infectious Enteritis
Hemiplegia
Encephalopathy
Aphasia
Portal hypertension
Jaundice
Ulcerative colitis
Obstruction of bile duct
26
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Proposed deletion for current CC list
Dehydration
Acute/chronic blood loss anemia
Angina
CHF
COPD
Atrial Fibrillation
Chronic Renal Failure
Seizure Disorder
27
Behavioral Adjustment(Impact Coding)
28
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Behavioral Adjustment
The proposed rule also includes a 2.4 percent cut to both operating and capital payments in both FYs 2008 and 2009 –$24 billion over five yearsImprove payment based upon patient severity and resources
29
Maryland is using APR-DRGs
30
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
APR-DRGs in Maryland
3M’s All-Patient Refined DRGs (APR-DRGs) APR-DRGs consider multiple CCs in determining the placement of the patient and, ultimately, the paymentAPR-DRGs consider interactions among primary and secondary diagnoses APR-DRGs consider interactions among procedures and diagnoses as well. (MS-DRGs do not)APR-DRGs have four severity subclasses for each base DRG, while MS-DRGs have three tiersLess than half the number of patient classifications in the MS-DRG system are dependent on the presence or absence of a CC – 410 for MS-DRGs versus 863 for APR-DRGsSo significant differences in the two systems
31
Coding Improvement
Hospitals are already coding as carefully and accurately as possible because of other incentives in the system to do so, such as risk adjustment in various quality reporting systems • An article in the magazine Healthcare
Financial Management
32
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
33
Replaced Devices
Reduce the amount of IPPS payment when:1) A full or partial credit towards a
replacement device is made2) The device is replaced without
cost to the hospital3) A full credit for the removed device
34
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
New Technology Add On Payments
Discontinue add-on payment• GORE TAG• Restore• X STOP
New Applicants• Wingspan
35
List of ICD-9-CM diagnosis and procedure code revisionsList of proposed MS-DRGs
Other Changes (Impact Coding)
36
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Hospital Acquired Conditions, including Infections
(Impact Coding)
37
Data Collection via POA
POA was approved due to the increased concern with healthcare quality and payment being increased (via DRGs) when a complication occurred that the hospital was responsible for.• Better tracking of hospital acquired infections,
accidents and adverse eventsA patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively he developed a pulmonary embolism. • Assign “N” on the POA field for the pulmonary
embolism. This is an acute condition that was not present on admission 38
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
“Never Events” –IPPS and POA ImpactThe CMS IPPS 13 proposed conditions (and their ICD-9-CM codes) include:
• Catheter-associated urinary tract infection (996.64 and various urinary tract infection codes)
• Pressure sores (707.00-707.09) • Object left in surgery (998.4) • Air embolism (999.1) • Delivery of ABO-incompatible blood products (999.1) • Staphylococcus aureus septicemia (038.11) • Ventilator-associated pneumonia (999.9 + pneumonia code) • Vascular catheter-associated infection (996.62) • Clostridium difficile-associated disease (008.45) • Methicilllin-resistant staphylococcus aureus infection (V09.0) • Surgical site infections (998.59) • Surgery on wrong body part, patient, or wrong surgery (E876.5) • Patient falls (no code)
CMS is seeking public comment to determine which of these measures (at least two) to implement for 2008. 39
2 or more conditions…
NoYes YesYes-high cost in specific circumstances
Yes4. Air embolism
NoYes YesYes-high cost in specific circumstances
Yes3. Object left in surgery
NoYesYesYesYes2. Pressure Ulcers (Decubitus Ulcers)
Minimal-additional infection codes
YesYesYesYes1. Catheter associated UTI
Considera-tions?CC?
Prevention guidelines?
High cost and/or high volume?
Unique Code?
Proposed Hospital-Acquired Conditions
40
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Notes/Comments/Questions
2 or more conditions continued….
Multiple codes
Yes YesYesYes-multiple codes reported
6. Staphylococ-cus aureus septicemia
NoYes YesYes-high cost in specific circumstances
Yes5. Blood incompati-bility
Considera-tions?
CC?Prevention guidelines?
High cost and/or high volume?
Unique Code?
Proposed Hospital-Acquired Conditions
41
New Legal Ramifications “Never Events”
When an event occurs during a hospital encounter or stay that was not expected, should the event result in additional revenue to the provider?CMS believes this impacts quality of care Proposed IPPS rule will address this…
42
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
A little more about POA
43
Present On Admission Indicator Definitions (Impact Coding)
Y = YesCondition is present at the time of inpatient admission
N = NoCondition not present at the time of inpatient admission
U = UnknownDocumentation is insufficient to determine if the condition is present on admission
W = Clinically UndeterminedThe provider is unable to clinically determine whether condition was present on admission or not
Unreported/Not Used – Exempt from POA reportingThis option is the only circumstance in which thePOA field is left blank. The condition needs to be on the list of ICD-9-CM codes for which this field is not applicable. 44
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
CMS Transmittal 1240;Change Request 5499
POA is required 10/1/07• The information will not be used by the claims
processing systems until January 1, 2008
CMS will process on claims 1/1/08• Hospitals will be provided with a remark code
on their RA advising them that they did not correctly submit the POA code on the claim
Returned To Provider 4/1/08 • If hospitals do not report a valid POA code for
each diagnosis on the claim, the claim will RTP for correct submission of POA information
45
Deficit Reduction Act 2005
Requires that the Present on Admission indicator be collected for all Medicare patients beginning October 1, 2008Requires CMS to select two or more conditions that are high cost/high volumeRequires CMS to begin excluding those conditions from the calculation of the DRG when they are identified as not present on admission beginning October 1, 2008
46
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
What will happen in October 2008? (Impact Coding)
For the conditions that have been chosen, if that condition is the only “cc” on the claim, the claim will be paid at the lower weighted DRG. • Example:
• Patient admitted with acute atrial fibrillation and developed a decubitus ulcer* during the hospitalization which is identified by a POA of “N”.
• The DRG assignment would be DRG 138 (current CMS DRG) or MS-DRG 309.
• Payment for this case would be calculated as if the decubitus ulcer was not present – therefore, DRG 139 (current CMS DRG) or MS-DRG 310.
47
POA Examples
Patient is admitted from the ED for a diagnostic work up for chest pain. The final diagnosis was myocardial infarction.
Assign “Y” in the POA field for the myocardial infarction. Although not identified on admission, diagnostic work up confirmed the final
A patient undergoes outpatient surgery for a hernia. During recovery, the patient develops atrial fibrillation and is admitted to the hospital
Assign “Y” in the POA field for atrial fibrillation since it developed prior to an inpatient admission order.
48
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
POA Examples
A 25 year-old female is admitted for labor and subsequently delivers a normal newborn
Leave the POA field blank. Code 650, Normal delivery is on the exempt from reporting list.
49
Polling Question #2
Will your facility be ready to submit POA indicator beginning in October, 2007?
*1 Yes*2 No*3 Unknown
50
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Notes/Comments/Questions
What Are Others in the Industry Saying??
51
What Should HIM and Coding Professionals Do Now to
Prepare for the Potential IPPS Changes??
52
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
Don’t be Encoder Dependent
Coders need to review carefully the final code that the encoder software is providingUse your ICD-9-CM code book• Alpha and Tabular
Documentation must support the assignment of the code.Coding from memory is dangerous• Coding guidelines change –
Quarterly Coding Clinic
53
HIM Coding Action and Next Steps
Additional education – specific and one-on-one?Have coding staff “shadowing” while on clinical rounds?Reaudit documentation and codingAudit POA reporting• Make physicians aware of POA
Use your ICD-9-CM books!Increase anatomy/physiology knowledgeIncrease pharmacology
54
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
HIM Coding Action Steps
Recognize core coding concepts remain the same • Accurate and Complete Coding
• UHDDS Definition to support code assignment
• Physician Documentation is key• Continue to increase knowledge of
disease processes and anatomy and physiology
55
HIM Coding Action Steps
Become the experts • MS-DRG
methodology and related changes
• You are here today• Keep up with
industry information
Create awareness:• Senior Management • IS personnel • Department
Directors • Financial Team• Local contract team
56
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
HIM Action Steps
Understand system impact• 3M Coding and Reimbursement Software• Meditech• Patient Accounting• Case Mix
Mission critical will be preparation for claim submission
57
HIM Action Steps
Inventory• Internal facility
uses of the DRGs for business purposes
• Internal facility applications that contain a DRG
Initiate• Discussions with
other facility negotiated payers that currently use DRG
• Will other payers change to MS-DRG
• May continue with an updated DRG grouper
– Associated cost
58
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
HIM Action Steps
Plan NOW to:• Order coding resources in a timely
manner• Assess gaps in medical record
documentation• Clinical Documentation Improvement
59
HIM Coding Action Steps - Clinical Documentation Improvement
Recommended action steps• Run facility secondary diagnosis volume
data• Review high volume diagnoses• Understand impact of proposed MS DRGs• Identify opportunities for improvement
60
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
HIM Coding Action Steps
Prior to MS-DRG/IPPS changes: • Expect more training and education• Work to ensure coding is up to date prior to
transition• Evaluate any necessary change in any
processes, policies, and procedures• Assess gaps in medical record documentation• Continue emphasizing medical
staff responsibilities
61
HIM Coding Action Steps –specifically for POA
All of your coders should become familiar with the POA indicators and corresponding POA Reporting GuidelinesWork will need to begin to educate and prepare others throughout the facility for this requirement.• Level I – Facility Leadership, Department Directors,
Nursing staff, HIM staff• Level II – Medical Staff, Case Managers, PAs,
Revenue Integrity• Level III – Coders, Coding Managers/Supervisors
62
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
HIM Coding Action Steps –Specifically for POAReview current policiesEstablish any new processes needed • Incorporate POA into QC process
Think about any potential operational impact• Productivity• A/R• Queries
Prepare to educate medical staff on the continued emphasis and importance of their documentation and of your clinical documentation improvement plan
63
Summary
Regulations require healthcare providers to capture all clinical data with new emphasis on complication and “never events”Clinical documentation is at the centerLinkage of documentation to the coding and payment systems continuesThere is a linkage to Quality measures and scorecards of performance from documentation and codingCoding rules and guidelines
64
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
CMS IPPS Comments
CMS will now review the comments: Where sent to:Leslie Norwalk, Esq.Acting AdministratorCenters for Medicare & Medicaid ServicesHubert H. Humphrey Building200 Independence Avenue, S.W., Room 445-GWashington, DC 20201
Watch for the final rule
65
References and Resources
Medicare Hospital ManualFederal Register, CMS, HHSMedicare Customer Service Department 1-877-567-3094AHA Coding ClinicFaye Brown ICD-9-CM HandbookWeb Med (eMedicine)The IPPS Proposed Regs at:• http://www.access.gpo.gov/su_docs/fedreg/a070503c.html
The RAND report at:• http://www.cms.hhs.gov/reports/downloads/wynn0307.pdf
CMS Transmittal 1240: POA• http://www.cms.hhs.gov/transmittals/downloads/R1240CP.pdf
AHIMA’s Comments on IP-PPS proposed changes and RY2008 Rates • http://www.ahima.org/dc/documents/MicrosoftWord-
AHIMAcomments-IP-PPS08_fin6-7-2007.pdf66
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Notes/Comments/Questions
AHIMA Resources
Coding Assessment and Training Solutions Online TrainingDRG Systems Adjusted for Severityhttp://campus.ahima.org/campus/course_info/CATS/CATS_newtraining.html#drg
67
Audience Questions
Proposed MS-DRGs: A Coding Perspective
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Notes/Comments/Questions
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Proposed MS-DRGs: A Coding Perspective
AHIMA 2007 Audio Seminar Series 36
Notes/Comments/Questions
Upcoming Audio Seminars
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print their CE certificate
Certificates will be awarded for AHIMA and ANCC
Continuing Education Credit
Appendix
AHIMA 2007 Audio Seminar Series 37
CE Certificate Instructions
To receive your
CE Certificate
Please go to the AHIMA Web site
http://campus.ahima.org/audio/2007seminars.html click on
“Complete Online Evaluation”
You will be automatically linked to the CE certificate for this seminar after completing
the evaluation.
Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view
and print the CE certificate.