Note: RAC DRG validation audits begin
Medicare Weekly Update, December 8, 2009
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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.
CMS has approved Connolly Healthcare, the recovery audit contractor (RAC) for Region C, to begin DRG validation audits. The states of Alabama, Colorado, Florida, Georgia, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas will soon see requests for medical records for these complex reviews.
According to Connolly, DRG validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary’s medical record. The supporting documentation and the coding of such must follow the ICD-9-CM Official Coding Guidelines and the related Coding Clinic. Connolly has posted an extensive list of twenty four MS-DRGs that are up for review.
Click over to the MedicareMentor Blog to read more.
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