Bencmark for severity query rate

agreen915@yahoo.com

I am looking for benchmarks for severity query rate.Does anyone have any information on this benchmark? Thank you

Angie Green RN
Manager Clinical Documentation Improvement
IU Health, Indianapolis, IN

nahasits

We were told 40%. The SOI queries are most valuable when trying to keep our DRG-moving co-morbidities during audit. That's why that percentage so high. We might not see revenue change from that second MCC, but it may protect that case from audit.
Regards,
Carol Carl RN, CCDS

Sent from my Verizon Wireless 4G LTE DROID

annnd2009@gmail.com

Hi
I'm trying to understand this. Meaning 40% of all our queries should be
primarily affecting SOI? Meaning 60% should be revenue producing?

With the apr-drg calculator on a Medicare patient with a second MCC what is
the significance of increasing SOI/rom in these cases?

I understand increasing CMI,I understand getting second cc/mcc to audit
proof chart, I (think ) I understand wanting "death charts" to be 4/4 to
show their was reason for death... But I don't understand how the SOI/rom
makes a positive impact otherwise (in Medicare).
Medicaid effect is too big for same discussion but know there is more if a
relationship,right?

Thanks for any clarification.

Thanks,
Ann


Sent from my iPhone

nahasits

It was explained to us that auditors will run the codes of the DRGs submitted. In order for them to make impact for themselves by taking money back, they must focus on DRGs that currently have only one CC or MCC. Those are the easiest DRGs to bump down. However, a case coded to a DRG with two MCCs or two CCs will be more difficult to turn over, and therefore less of an audit target. The SOI queries will not show immediate revenue capture (unless you are working toward incentives established by the insurance companies to meet core measures and such). Their value is in the money kept, and that metric is very difficult to track. But still important.
I hope this helps.
Carol