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Tip of the week: Dig deeper into your data to receive better reimbursement

Case Management Weekly, August 31, 2005

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Low-cost or free data are available to help you track your facility's efficiency and benchmark your LOS. Take advantage of these resources to analyze your data and to see how your facility stacks up, says Cass Schaedig, principal of Trellis Healthcare Consulting in Denver. For example, on its Web site, www.cms.hhs.gov, the Centers for Medicare & Medicaid Services offers LOS benchmarks sorted by DRG. Reports include arithmetic mean LOS and statistics by DRG per year. If you find that your typical LOS for a certain DRG is higher than average, you may need to question your coding efficiency/appropriateness. Remember that the Medicare average LOS is based on older, sicker patients. So if your commercial patient population has a higher average LOS than Medicare, you may have a problem. "Look at your case mix," Schaedig says. If it's lower than that of your peers, your facility could be undercoding. Schaedig often does this kind of comparison for cardiac services. A cardiac patient could have chest pain, heart failure, or arrhythmia. Coding for these conditions may get your facility a higher rate of severity, but if your coding rate for these conditions isn't in line with that of your peers, your facility should conduct coding audits on these types of cases. "Being more creative in using the data made available to you helps to identify gaps in processes or potential revenue improvement," she says.

Source: Briefings on Coding Compliance Strategies, February 2005, HCPro, Inc.

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