Slide 1 - Virginia Health Information Management Association ...

MS-DRGs – The First Six Months Update

April 2008

Virginia HIMA Annual Convention

Melinda S. Stegman, MBA, CCS

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Agenda – MS-DRGs

Brief overview

New concepts introduced with MS-DRGs

Conditional MCCs

MCCs and CCs excluded by DRG definition

Procedure Proxies

Undocumented changes, inconsistencies and what really happened (MDCs 03 and 09)

Relative Weight issues

Potential overcoding (maximizing): Beware

MS-DRGs and RAC Issues

Conclusions

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MS-DRG Basics

Officially named MS-DRGs (Medicare Severity) Built on CMS DRGs (similar subgroups) 745 final DRGs numbered from 001 to 999 Explanation of variance in consumed hospital resources

increased over previous DRGs by 9.41% Major overhaul of previous CCs 1, 2 and 3-way splits based on CC or MCC

With MCC, with CC or without CC/MCC (e.g. concussion, major chest procedures)

With CC/MCC or without CC/MCC (e.g. bronchitis or asthma) With MCC or without MCC (e.g. seizures, headaches) No splits (e.g. angina pectoris, chest pain)

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Conditional MCCs

Certain MCCs are excluded from list unless the patient is discharged alive 427.41(ventricular fibrillation)

427.5 (cardiac arrest)

785.51 (cardiogenic shock)

785.59 (other shock without mention of trauma)

799.1 (respiratory arrest)

If the patient expires, the conditions above are considered non-CCs

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MCCs and CCs Excluded by DRG Definition

Many MS DRGs use secondary diagnoses as part of the DRG definition E.g.: MS DRG 280/281/282 AMI, Discharged Alive

– Must have principal dx in MDC 05, any dx of AMI Initial Episode

If a diagnoses is part of the definition of a DRG it is excluded from being a CC/MCC by the DRG (even if the diagnosis is not used in DRG assignment) E.g.: 410.01, 410.11, 410.21, 410.31, 410.41,

410.51, 410.61, 410.71, 410.81, 410.91 are excluded from being MCC in MS DRG 280, even if more than one is present.

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MCCs and CCs Excluded by DRG Definition

Breast Malignancy (198.2, 198.81)582 – Mastectomy for Malignancy

Acute Leukemia (204.00, 204.01, 205.00, 205.01, 206.00, 206.01, 207.00, 207.01, 208.00,

208.01)

837, 838 – Chemotherapy with Acute Leukemia as SDx or with High Dose Chemotherapy Agent (only cases with acute Leukemia as SDx)

Full Thickness Burn (941-949)928 – Full Thickness Burn w Skin Graft or Inhalation Injection

Significant Trauma (Many Dxs)957, 958 – Other O.R. Procedures for Multiple Significant Trauma

Significant Trauma (Many Dxs)963, 964 – Other Multiple Significant Trauma

HIV (042) and HIV Related Conditions (Many Dxs)

974, 975 – HIV with Major Related Condition

AMIs (410.01, 410.11, 410.21, 410.31, 410.41,

410.51, 410.61, 410.71, 410.81, 410.91)

283, 284 – AMI, Expired

AMIs (410.01, 410.11, 410.21, 410.31, 410.41,

410.51, 410.61, 410.71, 410.81, 410.91)

280, 281 – AMI, Discharged Alive

Traumatic stupor and Coma Dxs (800-804, 851-854)

082, 083 – Traumatic Stupor and Coma, Coma > 1 hour

Excluded CC/MCC DxsMS-DRG

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MCC/CC Capture Rates

CMS has estimated that MCC/CC Capture Rates would decrease to approximately 40% nationally.

Does your facility calculate MCC/CC Capture Rates on a routine on-going basis?

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Procedures Used as “Proxy” for MCC/CCs

DRG 024 Craniotomy w major device … w/o MCC ==>DRG 023 Craniotomy w major device… w MCC or chemo implantwith 00.10 (implantation of chemotherapeutic agent)

DRG 030 Spinal procedures w/o CC/MCC ==> DRG 029 Spinal procedures w CC/MCC or spinal neurostimulators with combination of 03.93 and 86.94, 86.95 or 86.97

DRG 042 Peripheral & cranial nerve proc… w/o CC/MCC ==> DRG 041 Peripheral & cranial nerve proc… w CC or peripheral neurostimulators with a combination of 04.92 and 86.94, 86.95, 86.97 or 86.98 DRG 040 Peripheral & cranial nerve proc… w MCC

DRG 130 Major head & neck procedures w/o MCC ==>DRG 129 Major head & neck procedures w MCC or major device with 20.96 or 20.97 or 20.98 (cochlear implants)

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DRG 238 Major cardiovascular procedures w/o MCC ==> DRG 237 Major cardiovascular procedures w MCC or thoracic aortic aneurysm repair with 39.73 (Endovascular implantation of graft in thoracic aorta)

DRG 247 Percutaneous CV procedure w drug-eluting stent w/o MCC ==> DRG 246 Percutaneous CV procedure w drug-eluting stent w MCC or 4+ vessels/stents with combination procedures (00.66 and 36.07) with 00.43 or 00.48

DRG 249 Percutaneous CV procedure w non-drug-eluting stent w/o MCC ==> DRG 248 Percutaneous CV procedure w non-drug-eluting stent w MCC or 4+ vessels/stents with combination procedures (00.66 and 36.06) with 00.43 or 00.48

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DRG 491 Back & neck procedure exc spinal fusion w/o CC/MCC DRG 490 Back & neck procedure exc spinal fusion w CC/MCC or disc device/neurostimulator with 84.59, 84.62, 84.65, 84.80, 84.82, 84.84 OR combination 03.93 and 86.94, 86.95, 86.97 or 86.98

DRG 839 Chemo w acute leukemia w/o CC/MCC ==>DRG 838 Chemo w acute leukemia w CC or high dose chemo agent with 00.15 (hi-dose infusion of interleukin-2) DRG 837 Chemo w acute leukemia w MCC or high dose chemo agent with 00.15 (hi-dose infusion of interleukin-2)

DRG 006 Liver transplant w/o MCC ==> DRG 005 Liver transplant w MCC or intestinal transplant with 46.97 (Transplant of intestine)

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Undocumented Changes & Inconsistencies by CMS

Inconsistencies in CMS documentation Table F (Final Rule; Federal Register; Vol. 72,

No. 162, August 22, 2007, page 47156) CMS-DRG to MS-DRG crosswalk (both in

Proposed Rule and Final Rule)

YesSkin Graft and Debridement

CMS DRG Model, MDC 9 - Diseases & Disorders Of The Skin, Subcutaneous Tissue & Breast (CMS-DRGs)

263

268

267Perianal and Pilonidal Cyst Procedures

Plastic Procedures

No

O.R.Procedure

2

Yes

No

S u r g ic a lP a r t it io n in g

PDX Skin Ulceror Cellulitis CC

Yes

No 264

CC

265

No 266

Yes

1

CMS DRG Model, MDC 9 - Diseases & Disorders Of The Skin, Subcutaneous Tissue & Breast (CMS-DRGs)

257

258

259

260

Total MastectomyMastectomy andAny DX of Breast

Malignancy

Yes

1

Yes

NoCC

Subtotal Mastectomy

Yes

NoCC

261

262

2 6 9

2 7 0

No

Breast without Biopsy and Local Excision

Breast Biopsy and Local Excision

Ye s

N o

C C , O t h e r S k in S u b c u t a n e o u s T is s u e a n d B r e a s t P r o c e d u r e s

Unrelated ORLogic

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MDC – 09 Surgical Hierarchy Under MS-DRGs

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MDC – 09 Surgical Hierarchy Under MS-DRGs

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Unintended Consequences

Procedures in V24 DRG 269, 270 have leapfrogged in the surgical hierarchy procedures in V24 DRGs 257-260

This means cases with the following procedures will take precedence OVER mastectomies: 86.09 – Skin & Subq Incision NEC 86.3 – Other Local Destruc Skin

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MDC 03 - What was Documented

The Final Rule:

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MDC 03 - What was Documented - Inconsistencies

CMS Crosswalk from CMS-DRGs to MS-DRGs:

063

062

061

060

059

058

057

056

Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC134055

Other ear, nose, mouth & throat O.R. procedures w CC/MCC133S03052

Cranial/facial procedures w/o CC/MCC132

Cranial/facial procedures w CC/MCC131S03

CommentsMS-DRG Descriptions MS v25medsurgmdcCMS V24

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MDC 03 – What happened

049 - Major Head & Neck Procedures 129/130 - Major Head & Neck Procedures

061/062 – Myringotomy w Tube Insertion131/132 – Cranial/Facial Bone Procedures

053/054 – Sinus & Mastoid Procedures

133/134 – Other Ear, Nose, Mouth & Throat Procedures

168/169 – Mouth Procedures

057/058 – T&A Procedures Except T&A Only (T&A Procs)

057/058 – T&A Procedures Except T&A Only (Other T&A Procs)

052 – Cleft Lip & Palate Repair

056 – Rhinoplasty

050 – Sialoadenectomy

051 – Salivary Gland Procedures Except Sialoadenectomy

055 – Misc Ear, Nose, Throat & Mouth Procedures

059/060 – T&A Only

063 – Other Ear, Nose, Throat & Mouth



139 – Salivary Gland Procedures

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056 – Rhinoplasty




059/060 – T&A Only





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056 – Rhinoplasty




059/060 – T&A Only





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056 – Rhinoplasty




059/060 – T&A Only





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056 – Rhinoplasty




059/060 – T&A Only





Non MDC 03 Procedures

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Procedure Codes from V24 DRG 055 in MS DRG 131/132 21.4 – Resection of the Nose 21.72 – Open Resection of Nasal Fracture

Procedure Codes from V24 DRG 063 in MS DRG 131/132 16.52 – Exenteration Orbit Therapeutic Removal Orbital Bone 16.98 - Other Operations on Orbit 76.01 – Sequestrectomy of Facial Bone wo Division 76.19 – Other Diagnostic Procedures on Facial Bones and Joints 76.2 – Local Excision or Destruction of Lesion of Facial Bone 76.39 – Partial Ostectomy of Other Facial Bone 76.43 – Other Reconstruction of Mandible 76.44 – Total Ostectomy of Other Facial Bone w Synchronous Reconstruction 76.45 – Other Total Ostectomy of Other Facial Bone 76.46 – Other Reconstruction of Other Facial Bone 76.61 – Closed Osteoplasty (Osteotomy) of Mandibular Ramus 76.62 – Open Osteoplasty (Osteotomy) of Mandibular Ramus 76.63 – Osteoplasty (Osteotomy) of Body of Mandible 76.64 – Other Orthognathic Surgery of Mandible

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Procedure Codes from V24 DRG 063 in MS DRG 131/132 (con’t) 76.65 – Segmental Osteoplasty (Osteotomy) of Maxilla 76.66 – Total Osteoplasty (Osteotomy) of Maxilla 76.67 – Reduction Genioplasty 76.68 – Augmentation Genioplasty 76.69 – Other Facial Bone Repair 76.70 – Reduction of Facial Fracture, Not Otherwise Specified 76.72 – Open Reduction of Malar and Zygomatic Fracture 76.74 – Open Reduction of Maxillary Fracture 76.76 – Open Reduction of Mandibular Fracture 76.77 – Open Reduction of Alveolar Fracture 76.79 – Other Open Reduction of Facial Fracture 76.91 – Bone Graft to Facial Bone 76.92 – Insertion of Synthetic Implant in Facial Bone 76.94 – Open Reduction of Temporomandibular Dislocation 76.97 – Removal Internal Fixation Device Facial bone 76.99 – Other Operations on Facial Bones and Joints

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Non MDC 03 Procedure Codes from V24 in MS DRG 131/132 01.23 – Craniotomy and Craniectomy; Reopening of Craniotomy Site 01.24 – Other Craniotomy 01.25 – Other Craniectomy 01.6 – Excision of Lesion of Skull 02.01 – Opening of Cranial Suture 02.02 – Elevation of Skull Fracture Fragments 02.03 – Formation of Cranial Bone Flap 02.04 – Bone Graft to Skull 02.05 – Insertion of Skull Plate 02.06 – Cranial Osteoplasty 02.07 – Removal of Skull Plate 02.99 – Other Operations on Skull, Brain, and Cerebral Meninges; Other 16.01 – Orbitotomy with Bone Flap 16.02 – Orbitotomy with Insertion of Orbital Implant 16.09 – Other Orbitotomy 16.51 – Exenteration of Orbit with Removal of Adjacent Structures 16.59 – Other Exenteration of Orbit 16.63 – Revision of Enucleation Socket with Graft 16.64 – Other Revision of Enucleation Socket 16.89 – Other Repair of Injury of Eyeball or Orbit 16.92 – Excision of Lesion of Orbit

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Relative Weights are NOT Consistent

DRGs based on medical knowledge should be higher in relative weight, are not necessarily: MS DRG 082 Traumatic Stupor and Coma, Coma > 1 hour with

MCC has a weight of 1.6724 MS DRG 085 Traumatic Stupor and Coma, Coma < 1 hour with

MCC has a weight of 1.6946

MS DRG 083 Traumatic Stupor and Coma, Coma > 1 hour with CC has a weight of 1.3328

MS DRG 086 Traumatic Stupor and Coma, Coma < 1 hour with CC has a weight of 1.2337

MS DRG 084 Traumatic Stupor and Coma, Coma > 1 hour without CC/MCC has a weight of 1.1106

MS DRG 087 Traumatic Stupor and Coma, Coma < 1 hour without CC/MCC has a weight of 0.9235

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Relative Weights are NOT Consistent

Like conditions don’t necessarily correspond to similar change in weights MS DRG 716 has a higher weight than MS DRG 718

– MS DRG 716 Other Male Rep. Sys. With PDX Malignancy without CC/MCC has a weight of 1.1310

– MS DRG 718 Other Male Rep. Sys. Without PDX Malignancy without CC/MCC has a weight of 1.0329

MS DRG 715 has a lower weight than MS DRG 717– MS DRG 715 Other Male Rep. Sys. With PDX Malignancy with

CC/MCC has a weight of 1.5300– MS DRG 717 Other Male Rep. Sys. Without PDX Malignancy

with CC/MCC has a weight of 1.5653

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Potential Overcoding Examples

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Potential Overcoding: Beware!

Number 1 high-dollar overcoded DRG subgroup: DRG 981 Extensive O.R. Procedure Unrelated to Principal

Diagnosis with MCC RW 4.5168 ($22,584) DRG 982 Extensive O.R. Procedure Unrelated to Principal

Diagnosis with CC RW 3.5417 ($17,709) DRG 983 Extensive O.R. Procedure Unrelated to Principal

Diagnosis without CC/MCC RW 2.9737 ($14,869)

Old DRG 468 FY07 RW 3.9880 ($19,940) Issue: what is the definition of principal diagnosis? Co-existing principal diagnoses: was the patient really

admitted for the treatment of BOTH conditions?

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Sequencing issues: Example: a patient with long-standing COPD is

admitted with acute exacerbation and superimposed pneumonia. The physician indicates that the exacerbation is likely due to the pneumonia. The patient is admitted and treated with IV antibiotics, steroids and nebulizers.

What is the principal diagnosis?

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Prior to 10/1/07, sequencing pneumonia first was best financially.

Since MS-DRGs include subgroups for COPD, the highest weighted one (with MCC) carries a higher RW than the simple pneumonia DRG.

BUT…don’t forget the sequencing rules. The patient was really admitted for pneumonia, which caused the COPD exacerbation.

For FY07For FY07

DRG 088

RW 0.8878 ($4,439)

DRG 089

RW 1.0376 ($5,188)

MS-DRG 195

RW 0.8398 ($4,199)

(with 496 as sdx)

MS-DRG 194

RW 1.0235 ($5,118)

(with 491.21 as sdx)

Pneumonia

MS-DRG 190

RW 1.1138 ($5,569)

COPD

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Infectious Diseases Don’t infer that any positive culture means a systemic

infection– Contaminants (such as staph epidermis)– Localized superficial infections (such as oral thrush

causing a positive yeast culture)– Look at the entire clinical picture

– Treatment options (extended IV antibiotics or anti-fungals)

– Length of stay

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Sepsis Do not code sepsis based on ONE progress note or

other mention in the documentation; it may have been considered a “rule-out” condition.

“Urosepsis” still codes to urinary tract infection “Line sepsis”

– Code 996.62 Infection/inflammatory reaction due to other vascular device, implant and graft should be PDX

– See Coding Clinic, 2nd Quarter 2004, page 16:– When a patient has sepsis due to the vascular catheter, code 996.62,

Infection and inflammatory reaction due to other vascular catheter, should be the principal diagnosis, followed by the appropriate sepsis code, generally a code from category 038 and a code from subcategory 995.9.

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Malnutrition May be due to insufficient intake, increased loss, increased

demand, or a condition that decreases the body’s ability to digest and absorb nutrients.

MCCs include:– 260 Kwashiorkor (not typically seen in U.S. hospitals)– 261 Nutritional marasmus– 262 Other severe, protein-calorie malnutrition

CCs include:– 263.2 Arrested development following protein-calorie malnutrition– 263.8 Other protein-calorie malnutrition– 263.9 Unspecified protein-calorie malnutrition

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Malnutrition Do not assign these codes based on documentation of

“unexpected weight loss” alone Look for in patients with:

– Chronic conditions: short-gut syndrome, GI infectious processes, GI malignancies, malabsorption syndromes: (celiac disease, cystic fibrosis, pancreatic insufficiency, Crohn’s disease, pernicious anemia)

– Acute conditions: severe burns, infection, surgery, trauma Measurable substantiation must be present in the record:

– Total protein (A/G Ratio)– Hemoglobin– Albumin– Vitamin deficiency

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Mechanical ventilation 96.70 Continuous mechanical ventilation for unspec duration 96.71 Continuous mechanical ventilation for < 96 hours 96.72 Continuous mechanical ventilation for > 96 hours

Do NOT assign these codes for: CPAP or BiPAP delivered through tracheostomy

– Forms of respiratory assistance– Augments the patient’s own breathing

Refer to Coding Clinic, 1st Quarter 2008, pages 8-9 Be sure to review your Ventilation forms in the record;

ensure that CPAP & BiPAP are differentiated

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Mechanical ventilation High-dollar DRG risk area All other medical MDC 4

DRGs have an average RW of 1.1255 ($5,628)

These DRGs are under scrutiny by RACs, other government auditors

All MS-DRGs 207 & 208 should be routinely reviewed internally

RW 5.1231

$25,616

RW 2.2463

$11,232

Codes:96.72 > 96 hours

Codes:96.70 Unspec duration

96.71 < 96 hours

MS-DRG 207MS-DRG 208

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Coagulopathy PDX documented as “Coumadin-induced coagulopathy” Some coders have been assigning:

– PDX: 286.5 Hemorrhagic disorder due to intrinsic circulating anticoagulants

– SDX: 578.X GI bleeding; 784.7 Epistaxis; 599.7 Hematuria; 786.3 Hemoptysis

“Coumadin-induced” means that this was either an adverse reaction or a poisoning

– Adverse reaction: sequence the bleeding condition as PDX– Adverse reaction: sequence the adverse reaction (E934.2) as SDX– Poisoning: sequence the poisoning (964.2) as PDX– Poisoning: sequence the bleeding as SDX

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Coagulopathy Refer to Coding Clinic, 3rd Quarter 2004, page 7 Don’t forget other helpful codes for Coumadin-related conditions

– 790.92 Abnormal coagulation profile– V58.61 Long-term (current) use of anticoagulants

Coumadin

PoisoningHemoptysisHematuriaEpistaxisGI BleedingCoagulopathy

$3,443$3,329$3,138$3,114$5,098$6,713

RW: 0.6886RW: 0.6658RW: 0.6276RW: 0.6227RW: 1.0195RW: 1.3426

PDX: 964.2PDX: 786.3PDX: 599.7PDX: 784.7PDX: 578.9PDX: 286.5

MS-DRG 918MS-DRG 204MS-DRG 696MS-DRG 151MS-DRG 378MS-DRG 813

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Debridement Differentiation of excisional and non-excisional is required

– Excisional (86.22): surgical removal or cutting away of devitalized necrosis or slough; may be performed in the operating room, emergency department or at the patient bedside

– Non-excisional (86.28): non-operative brushing, irrigating, scrubbing or washing away of devitalized tissue, necrosis or slough; may include whirlpool debridement

The problem is usually in the documentation (or lack thereof)– “Sharp” is not sufficient for excisional– The use of scissors does not necessarily equate to excisional

An excisional debridement may be performed by a nurse, therapist, physician assistant or a physician (Coding Clinic, 2nd Quarter 2000, page 9)

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Debridement Procedural details should be documented:

– Instruments used– Extent and depth of the procedure– Definite cutting away of tissue

Excisional debridement should NOT be assigned if performed as a part of the following procedures:

– Incision and drainage– Bursectomy– Amputation

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Debridement For excisional debridements, the code assigned should reflect

the deepest layer of tissue debrided– Fascia– Muscle– Bone

When there’s no specific indexed entry for a debridement site other than skin, look for other terms such as excision or destruction of lesion of that site.

– E.g., for excisional debridement of soft tissue– Excision, lesion

soft tissue NEC 83.39– Refer to Coding Clinic, 2nd Quarter 2006, pages 3-4

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Debridement In some cases, the questions related to depth

of debridement may relate the patient’s diagnosis.

– Necrotizing fasciitis -- Was fascia debrided?– Osteomyelitis – Was muscle, fascia or bone

debrided?– Decubitus ulcer – Was muscle or fascia debrided?– Complicated wound – Was muscle, fascia, tendon,

bursa or bone debrided?

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Debridement Coding Clinic, 1st Quarter 2008, page 3

– Must excisional debridement involve cutting outside or beyond the wound margin? Does the documentation specifically need to state this?

– “The clinical information published in Coding Clinic regarding excisional debridement and cutting outside of the wound margins was provided for informational purposes to aid the coder’s understanding. It was not intended as clinical criteria to report code 86.22.”

– Some review organizations (including RACs) were interpreting the “must involve cutting outside or beyond the wound margin” literally.

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Other RAC (MS-DRG) Related Target Issues

Single CC/MCC DRGs Major bowel procedures

– MS-DRG 330 Major small & large bowel procedures with CC– PDX of malignant neoplasm of intestine (15X.X)

– SDX (and only CC) of lymph node metastasis (196.X)

– PDX of diverticulitis (562.11)– SDX (and only CC) of abscess of intestine (569.5)

Issue: RAC is looking for diagnoses documented ONLY on pathology report

– Some coders are coding 569.5 for “microperforations” or “microabscesses” on pathology report. These are present in nearly ALL diverticulitis cases.

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Single CC/MCC DRGs Issue: RAC is looking for diagnoses documented ONLY on

pathology report See Coding Clinic, 1st Quarter 2004, page 20:

“When coding strictly from the pathology report, the coder is assigning a diagnosis based on the pathological findings alone without the attending physician's corroboration. Although the pathologist provides a written interpretation of a tissue biopsy, this is not equivalent to the attending physician's medical diagnosis based on the patient's complete clinical picture. The attending physician is responsible for and directly involved in the care and treatment of the patient.”

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Single CC/MCC DRGs Acute blood loss anemia (285.1) assigned as only CC for hip ORIF and

other related procedures Moves MS-DRG from 482 to 481 Hip & Femur Procedures Except Major

Joint (without and with CC) Refer to Coding Clinic, 1st Quarter 2007, page 19When postoperative anemia is documented without specification of acute

blood loss, code 285.9, Anemia, unspecified, is the default. Code 285.1, Acute posthemorrhagic anemia, should be assigned, when postoperative anemia is due to acute blood loss. Revisions were made to the Alphabetic Index in 2004, which direct the coder in the following manner:

Anemia postoperative due to blood loss 285.1 other 285.9

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Conclusions

Yes, MS-DRGs are similar to the old CMS-DRGs but we have different issues Watch sequencing; just because a particular sequenced set of

diagnoses gets you an MCC, it doesn’t mean it’s the appropriate code assignment for the case.

Medicare still accepts only 9 diagnoses and 6 procedures; make sure the most important and those reflecting the highest severity are ranked the highest in order.

The learning curve will improve and productivity may also, although possibly not back to pre-MS-DRG levels.

Ensure each condition addressed/treated is coded, but don’t overmaximize – Coding Clinic still rules.

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Conclusions

Most facilities are seeing: Increase in:

– Accounts Receivable (AR) dollars– Average time required to code an inpatient record– Number of physician queries required to code adequately and

completely for MS-DRGs– Need for physician education re: documentation specificity

Still to be determined:– Impact on CMI; this will largely be determined by size of facility and

types of services provided– Whether CMS’ idea of the need for a “behavioral offset” was

legitimate

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Conclusions

What everyone should be doing: Data mining; if the RACs, QIOs and other government agencies

are looking at your data, you should be too!– Start with some of the potential overcoding issues identified here– Track progress over time– Use public databases from the existing Payment Error Programs

– Hospital Payment Monitoring Program (HPMP)– Medicare inpatient cases– Previously called the Payment Error Prevention Program (PEPP)– Reviews that are performed by the QIOs– Monitor your Program for Evaluating Payment Patterns Electronic

Report (PEPPER)

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Questions?

It’s an exciting time in HIM, with MS-DRGs, POA, RACs, MACs, etc.

Please contact me if you wish –

[email protected]

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