Re-imbursement calculation

cynthia.a.goewey

We had a few questions come up in one of our meetings yesterday and we would like to see how the rest of you do this:

1. a. When calculating the financial impact of your query do you calculate the change from the initial DRG to the final DRG or do you calculate using the impact of your query on the final DRG assigned (e.g., pdx may have changed after study so the initial drg assigned is not pertinent)?
b. Is this a manual process or do you have a tool/program that calculates this for you?

2. Do you calculate a financial impact if your cc or mcc ends up not being the only one on the case (you queried and obtained the first cc or mcc but the patient developed others after your query response was documented)?

Thanks again,
Cindy

Cindy Goewey RN, BSN
Clinical Documentation Specialist
Coding Operations
Dartmouth-Hitchcock Medical Center
Phone: (603) 650-3891 / Fax: (603) 650-6787
Dartmouth-Hitchcock.org

kshumpert

I have to use a manual process right now. I have a column for CC/MCC and I keep track of them. I have a legend at the end of the report noting that CC/MCC have been added to the chart but did not affect reimbursement. I include that the addition of CC/MCC reflect a more accurate SOI/ROM and reduce the risk of a RAC targeted chart.


Kathy Shumpert, RN, BSN

Clinical Documentation Improvement Specialist
Howard Regional Health System
Office 765-864-8754
Pager 765-604-0424
Fax 765-453-8152

When something can be read without effort, great effort has gone into its
writing. ~Enrique Jardiel Poncela

fishdl@shands.ufl.edu

1 a. We calculate the financial impact using the impact of our query on the final MS-DRG assignment.
1 b. We use Softmed/ClinTrac to record and track our reviews, queries, physician responses, etc. and the 3M codefinder to establish our MS-DRG.
2. We do not claim the financial impact if additional CC/MCCs are coded.


Donna Fisher, CCS, CCDS
Lead Clinical Documentation Improvement Specialist
Health Information Management
Shands Healthcare at the University of Florida
352-265-0680 Ext 48769
fishdl@shands.ufl.edu

kari.eskens

1a. We calculate using the impact of the query on the final DRG.
1b. This is a manual process for us - tracked in Excel.
2. We do not claim financial impact if add'l CC/MCC are on the account.

Kari L. Eskens, RHIA
BryanLGH Medical Center
Coding & Clinical Documentation Manager

NormaB

We base the financial impact on our first assigned Queryb or our updated query DRG and the final coded DRG.

We have an Excel spreadsheet which calculates this on the base rate. We key in the information and it calculates the difference for us and keeps a running total.

We do not capture the information if another MCCor CC is documented besides the one for which we queried. We only want stats on how the CDS impacted the case.

roxanne.niemann

Cindy,

How did you develop your spreadsheet to autocalculate the financials
associated with the DRGs? Currently this is a manual process for us.

Thank you.


Roxanne Niemann, RN
Clinical Documentation
Morton Plant Mease Healthcare
727-298-6024 office
727-298-6761 fax
roxanne.niemann@baycare.org

catladyrn

I try to calculate what the DRG would have been, but for my intervention, and go from there.

Renee

Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

arobinso

I am just catching up on my emails when I seen this one, I am not Cindy but I had my IS dept build me a database in Access. It pulls my financial info from Star, still some manual labor, but beats calculating manually like I used to do.

Mandi Robinson, BS, RN, CPC
Clinical Documentation Specialist
Trover Health System
270-326-4982
arobinso@trover.org
"Excellent Care, Every Time"

cynthia.a.goewey

Thanks for your responses. Am glad to see we have been doing it as all of you have. For us it is a manual process and can be tedious, which is why I was asking if any of you had a tool which tracked and if so how did it calculate the financial impact. Have always been curious how a tool/program could calculate the financial impact if it cannot determine if there is another cc/mcc on the case.
Thanks,
Cindy

catladyrn

Roxanne, I am not Cindy, but you could easily create a spreadsheet that has the RW for each DRG. If you then load your blended rate, you can easily have Excel calculate the reimbursement. Then it becomes really easy, because at that point, you would simply have your spreadsheet set up so that if you enter two DRGs, it will then determine the $ difference between the two DRGs. It could also be done in Access.

You can even take CMS's spreadsheet and just add a column for your blended rate:
http://www.cms.gov/acuteinpatientpps/ffd/itemdetail.asp?itemid=CMS1230516 (go to Table 5)

A completely automated program is not going to know whether there was a reimbursement impact or not. There's always some manual element involved.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

NormaB

That's the way we keep up with our information. It keeps a summary that we can turn in monthly and then yearly. Then you sey it up for the next year.

N.Brunson, RHIA, CCDS

dbutler

1a -- RW shift DRG without the code resulting from query vs with code (ie, working to final DRGs).
b combined -- manual process to absolutely verify every query result and check on other codes assigned. Once working and final DRG affirmed, use and Access data base (home built) to do the calculations.

2 -- NEVER take credit for $ impact when another cc/mcc present -- always err on the side of caution!!
Does take quite a bit of time to examine each case, but well worth the confidence level when reporting metrics and measures of program success.

Don