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Tips to ease transition to the 2007 DRG changes

Healthcare Auditing Weekly, October 17, 2006

The 2007 IPPS final rule outlines enough DRG changes to make any coder's or HIM director's head spin. But there are simple ways to make the changes-effective for services on or after October 1, 2006-more manageable.

Try the following:

1. Analyze financial impact. Several states publish severity-adjusted data that facilities can use to perform analyses. Examining your case mix is a good place to start. Look at how many of your cases fall into old DRGs that will expand. Perform a similar analysis using the new DRG cost-based methodology to get a sense of how the changes will affect your service lines.

2. Appoint a coder advocate for DRG changes in each specialty. This person becomes the expert for DRG changes related to his or her specialty and then serves as an educator/coder champion.

3. Encourage coders to work with case managers for documentation improvement. If your facility is lucky enough to have or be able to appoint a nurse who can serve as clinical documentation improvement coordinator, you're better off. Also, encourage coders to interact with these individuals as well as physicians.

4. Establish a coder-physician alliance. As complications and comorbidities play a more important role in reimbursement, establishing this alliance will help educate physicians on proper documentation.

5. Evaluate your workflow processes. Consider hiring additional coding staff to lessen the impact of coding under a severity-adjusted system. Although coding rules won't change, coders may need to scour records more carefully to capture conditions that will affect reimbursement in ways that they didn't before.

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