Benchmark for MEDICAL CC/MCC Capture Rate
Assume – as quality of documentation rises, so too will the CC/MCC rates (APR-DRG Levels)
If so, How high can we expect the capture rate to rise?
Most CDI consulting firms use a benchmark of 50%-55% for a combined Surgical Capture Rate
(Source: Physician Queries Handbook, ACDIS, 2009)
I can find no benchmark for combined Medical Capture Rate? Any resources anyone can offer?
Paul Evans, RHIA, CCDS
If so, How high can we expect the capture rate to rise?
Most CDI consulting firms use a benchmark of 50%-55% for a combined Surgical Capture Rate
(Source: Physician Queries Handbook, ACDIS, 2009)
I can find no benchmark for combined Medical Capture Rate? Any resources anyone can offer?
Paul Evans, RHIA, CCDS
Comments
For our last report (ending in Dec 2013), our CDI consulting company reported the 80% benchmark as a combined CC/MCC capture rate for medical at 66% (29/37) and surgical at 60% (34/26). This is for Medicare ONLY.
Hope that helps
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
80% percentile @ 66% CC/MCC for Medical and 60% for surgical seems reasonable?
See you in Vegas!
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
evanspx@sutterhealth.org
Sent from my iPhone
Typical meaning as Katy has phrased:
At the 80th percentile performance (as opposed to the average
performance at 50th percentile), 66% of medical DRGs will have either a
cc or mcc.
So, if your capture rate is 66%, you are doing better than 80% of all
hospitals.
The caveat on Katy's benchmark -- she did not say if the benchmark is
based on MEDPARs data, or upon the consultant's internal data (which
might consist of only their clients). Since the original question was
for MEDPARs, and since that would be the more useful, I would presume
the consultant benchmark is for MEDPARs data.
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
DButler@vidanthealth.com
As to Don's point about MEDPAR vs Consultant. I am honestly not 100% sure if that is internal benchmarking or MEDPAR....
I hope that makes sense.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Paul evans
Sent from my iPhone
Management: Using Data to Drive Improvement, Nancy Rae Ignatowicz) that
referenced using MEDPARs data to benchmark MCC/CC capture rate, but
adjusted the MEDPARs data to reflect your own institution's DRG
distribution pattern.
I believe that as long as one has their own DRG distribution, the data
in the IPPS Table 7 can be used to come up with that adjusted benchmark.
Need to think through a process and the math to recreate that
benchmark.
Essentially, what you are seeking to do is if the normal % of CHF DRGs
in MEDPARs is 3%, and your hospital is 6%, a simple comparison will not
provide as good of a benchmark as if one 'adjusts' the MEDPARs to
reflect your DRG distribution and then calculate the MCC/CC capture.
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )
Sent from my iPad
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
provides some interesting elements that allow the development of an
approximate comparison group. With the data, one should be able to
develop a slightly better comparative CMI, perhaps some LOS, cost, etc.
for a fairly comparable selected group of hospitals.
Don
For EACH hospital in the country, data elements include:
Provider Number
Name
URGEO
Large urban, Other Urban or Rural designation of the providers
geographic CBSA
Resident to Bed Ratio
BEDS
Average Daily Census
Calculated as the ratio of Total Acute Inpatient Days to Total Days in
the Cost Reporting Period obtained from cost report data.**
REGION
1=NEW ENGLAND; 2=MIDDLE ATLANTIC; 3=SOUTH ATLANTIC; 4=EAST NORTH
CENTRAL; 5=EAST SOUTH CENTRAL; 6=WEST NORTH CENTRAL; 7=WEST SOUTH
CENTRAL; 8-=MOUNTAIN; 9=PACIFIC; 40=PUERTO RICO
Provider Type
Type of provider - key: 0=IPPS; 7=RURAL REFERRAL CENTER (RRC);
8=INDIAN; 14=Medicare Dependent Hospital (MDH); 15=MDH/RRC; 16=Sole
Community Hospital (SCH); 17=SCH/RRC; 21=ESSENTIAL ACCESS CMTY HSP
(EACH); 22=EACH/RRC; Reflects expiration of Medicare Dependent Hospital
payment status where providers have the provider type of 14 or 15 for FY
2014.
BILLS
Total number of Medicare cases for the provider from the FY2012 MEDPAR,
December 2012 Update
CMIV30
Case Mix Index under Grouper V30 for SCH/ former MDH providers paid
under their Hospital Specific Payment rate
CMIV31
Case Mix Index under Grouper V31 for SCH providers paid under their
Hospital Specific Payment rate
MCR_PCT
Medicare days as a percent of total inpatient days (not available for
all providers that receive HSP rate)
Proxy Value Based Purchasing Adjustment Factor
Proxy payment adjustment for value based purchasing program (Section
3001 of Affordable Care Act) based on performance scores from an older
performance period.
Final Readmission Adjustment Factor- Updated September 2013
Payment adjustment for Hospital Readmissions Reduction Program (Section
3025 of Affordable Care Act). Maryland and Puerto Rico hospitals are
exempt from the payment adjustment. Readmission Adjustment Factors are
based on excess readmission ratios from a performance period of July 1,
2009 to June 30, 2012. The excess readmission ratios include the
application of the planned readmissions algorithm.
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