Administrative Memos

200606

FROM: Theodore O. Will, Chief Executive Officer
DATE: Dec 01, 2006
SUBJECT: IPRO Medicare 8th Scope of Work HPMP Special Project: Statewide Aggregate Baseline Report - Reduction of Payment Errors in DRGS 174 & 182
IPRO CONTACTS:

George Davis, Ph.D., Assistant Director, Data Analysis & Evaluation, Medicare/Federal Healthcare Assessment, 516-209-5217

Enclosed please find a copy of IPRO's Aggregate Baseline Report on "Reduction of Payment Errors in DRG 174 (Gastrointestinal Hemorrhage with complication/comorbidity) and DRG 182 (Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders age>17 with CC)". After review, 13.3% of the cases were found to be in error. The admission denial error rate was 8% (48/600 cases) and the coding/DRG denial rate was 5.7% (34/600 cases).

As a result of these Special Project baseline findings, IPRO recommends that all hospitals:

Conduct ongoing internal auditing and monitoring to ensure the accuracy of DRG 174 and 182 assignments.
Provide continuing physician education in regard to appropriate and timely medical record documentation that supports coding/DRG assignment of gastrointestinal disorders with or without hemorrhage.
Provide continuing education to ER physicians in regard to the importance of documentation that supports identification/assessment of an acute problem that can only be managed in the inpatient setting.
Provide continuing education sessions for Health Information Management (HIM) professionals on correct documentation and coding rules and guidelines.
Assure complete and timely documentation of medical records such as transcribed discharge summary, history and physical, and operative procedure reports to support accurate assignment of codes and DRGs prior to submitting the claim.
Establish a code of conduct for coding processes. (You may wish to use the AHIMA Code of Ethics and Standards of Ethical Coding as your guide.)
Use IPRO project reports to compare DRG 174/175 and 182/183 performances to other New York State hospitals and, look for variations over time.
Incorporate the above activities into your hospital's Voluntary Compliance Plan.

In addition to the baseline review component, IPRO has also conducted targeted educational activities as well as developed resource materials to assist the hospital community in monitoring and reducing payment errors related to DRGs 174 and 182. Educational activities included project-related "webinars" that provided background, rationale and de-identified case examples illustrating admission necessity and coding/DRG concerns. Project based tools have included hospital-specific quarterly monitoring reports for DRGs 174 and 182, a project website containing all project related materials, and a coding booklet Coding for Quality: Documentation and Coding Tips for Gastrointestinal Disorders. All of these materials are available at http://www.ipro.org/gi.

If cases from your hospital were selected for our study, then in addition to the aggregate report (see Attachment I), a hospital specific comparative report is also provided (see Attachment II). Hospitals that have higher error rates as compared to the other hospitals in the baseline sample will be contacted by IPRO to schedule a conference call to discuss specific required corrective action.

To ensure rapid cycle improvement, IPRO will begin the re-measurement phase of the project during the first quarter of 2007. Therefore, we ask that hospitals implement improvements immediately to reduce inappropriate admission and coding/DRG errors so that these efforts are reflected in the re-measurement sample. In addition, if your hospital has had cases selected for baseline review, we will also be contacting you shortly to facilitate case identification and selection of the re-measurement sample.

Should you have any questions about this Memorandum or the attached reports, please feel free to contact George Davis, PhD, Assistant Director, Data Analysis & Evaluation, at 516-209-5217 or by email at gdavis@nyqio.sdps.org.