Assessment Instructions:You are the Coding Manager for a mid-size acute care hospital. Based on historical data, the hospital has decided to hold and review all cases that group to the following DRGs prior to claim submission:
192: Chronic obstructive pulmonary disease w/o CC/MCC
293: Heart failure and shock w/o CC/MCC
684: Renal failure w/o CC/MCC
689: Kidney and urinary tract infections w/ MCC
872: Septicemia w/o MV 96+ hours w/o MCC
It is your responsibility to review and present the quarterly audit results to the HIM Director. Analyze the following audit results. The facility averages 2,500 discharges per quarter.
Prepare a decision support (simulated) dashboard using the data on the table below that will summarize/compare individual and cumulative DRG results. Consider what information would be pertinent to leadership for decision-making and strategic planning and the best way to display this data – in dashboard format.
Total Reimbursement per Case
Number of Discharges
# Cases with errors resulting in an increase in reimbursement
# Cases with errors resulting in a decrease in reimbursement
In a brief recommendation to leadership (3-4 paragraphs), explain data mining. Discuss how leadership can use this information for performance improvement activities. Recommend at least one tool or technique to monitor ongoing improvements to this process: DRG accuracy.
REPORT facility-wide outcomes data (internally & externally)
UTILIZE data analytics for decision support, strategic initiatives, and research
EVALUATE utilization data for patterns, trends and opportunities for improvement
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