Don't code prematurely to ensure proper DRGs, hospital payments

Don't code hospital records prematurely, warns Donna Wilson RHIA, CCS, CCDS, senior director at Compliance Concepts, Inc. Wilson's advice follows a recent article from The Centers for Medicare & Medicaid Services (CMS)'s MedLearn Matters about inpatient DRG coding vulnerabilities.

Succumbing to the pressures of financial deadlines, many hospitals code and finalize claims before the final patient discharge summary is documented, which sometimes contains important test results not included in the initial diagnosis. Therefore, hospitals may open themselves up for errors and denials, according to Wilson.

"Best practice is to wait on the complete medical record since rebilling could result in a higher-weighted DRG that will automatically be reviewed by the QIO (quality improvement organization)," Wilson told an interviewer.

To address the financial deadlines, consider using staff to ensure appropriate coding in a timely way.

"If internal financial policies lessen their bill hold timeliness, then the discharge summary could be available and reviewed by a coding quality coordinator to ensure coding compliance," Wilson said.

For more:
- read this interview with Wilson, by the Revenue Cycle Institute

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.