Revenue Cycle

CMS discloses DRG coding vulnerabilities for inpatient hospitals

Recovery Auditor Report, June 30, 2011

In an effort to provide helpful information to providers, CMS released a special edition MedLearn Matters (MLN) article that disseminates DRG coding vulnerabilities for inpatient hospitals.

Recovery auditors review the entire medical record when performing DRG validation reviews, but oftentimes hospitals code the record prematurely, according to Donna Wilson RHIA, CCS, CCDS, senior director at Compliance Concepts, Inc. in Wexford, PA.

“As we know, hospitals code and finalize the claim without the final discharge summary documentation, given the struggles in meeting bill hold deadlines imposed by financial deadlines,” she says. “External auditors—such as the recovery audit contractors (RACs)—have access to the entire medical record, which includes the discharge summary.”

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