• Optum Edge
Know the major factors involved in moving a patient from a lower-paying MS-DRG to a higher one to receive optimal payment while staying in compliance.
• Optum Edge —Recovery audit contractor (RAC) program resource.
Understand the types of reviews, target strategies, and targeted and top-audited DRGs.
• Optum Edge —Present-on-admission (POA) tutorial with source documentation table.
Summarizes AHA Coding Clinic references concerning documentation issues and how they relate to assigning appropriate diagnosis codes.
• Optum Edge —DRG decision trees.
Clearly understand the logic behind assigning a DRG within an MDC. Available on the eBook and our exclusive DRG Desk Reference website.
• Optum Edge —DRG history and overview.
Includes an overview of the basic characteristics of the DRG classification system and development of the MS-DRG system, history, and relationship to the IPPS.
• Optum Edge —Documentation specificity tables.
Locate diagnoses that require additional physician specificity in documentation in order to assign a code that is designated an MCC or CC such as CHF, COPD, arthropathies, and ESRD.
• Abnormal EKGs, noninvasive diagnostic test findings and abnormal laboratory finding indicators.
Recognize key indicators of possible missed CC and MCC condition reporting based upon clues found in the medical record.
• Newly deactivated and most commonly missed CC and MCC references.
Perform accurate audits by knowing the most commonly missed CCs in the medical record.
• ICD-9-CM codes for common diagnoses and procedures.
Quickly identify the key diagnosis or procedure by ICD-9-CM code.
• Case mix index section.
Discusses the importance of calculating and tracking case mix on a regular basis as well as tips for documenting case mix index changes and their causes.
• Key fields for coder abstracting.
Includes abstracting basics, elements, code edits, and compliance-related issues associated with abstracting.
• Complete CC and MCC list.
Know how codes considered MCCs and CCs will affect DRG assignment—helping to legitimately improve reimbursement.
• Relative weights of every valid DRG.
A quick reference of the relative weights of all DRGs presented as options for optimizing.
• Drug usage and treatment indicators.
Help coders identify drugs, determine actions, and know the common CC and MCC conditions with which they are associated to help ensure the appropriate DRG is assigned.
Improve DRG accuracy by knowing each specimen of organism that indicates a CC condition.
• Summary of changes to the IPPS.
Understand the new provisions for identifying new medical services and technology that affect add-on payments.
Exclusive to the eBook format:
- Complete CC and MCC exclusion list. List of CC and MCC conditions and the principal diagnoses for which the condition does not qualify to be a CC or MCC, and therefore cannot be moved to a higher-paying DRG.
- Time-saving eBook features. Table of contents instantly links the user to any chapter, and PDF features allow the user to move back and forth between views quickly. Plus, you can quickly find the information you are looking for with keyword searches.
- DRG assignment tutorial.
- User may create additional bookmarks.