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historical data

historical data

April 19, 2022 by B3ln4iNmum
Assessment Instructions:You are the Coding Manager for a mid-size acute care hospital. Based on historical data, the hospital has decided to hold and review all cases that group to the following DRGs prior to claim submission:

192: Chronic obstructive pulmonary disease w/o CC/MCC

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293: Heart failure and shock w/o CC/MCC

684: Renal failure w/o CC/MCC

689: Kidney and urinary tract infections w/ MCC

872: Septicemia w/o MV 96+ hours w/o MCC

It is your responsibility to review and present the quarterly audit results to the HIM Director. Analyze the following audit results. The facility averages 2,500 discharges per quarter.

Part 1

Prepare a decision support (simulated) dashboard using the data on the table below that will summarize/compare individual and cumulative DRG results. Consider what information would be pertinent to leadership for decision-making and strategic planning and the best way to display this data – in dashboard format.

DRG Total Reimbursement per Case Number of Discharges Cases with

DRG/Coding Errors

# Cases with errors resulting in an increase in reimbursement # Cases with errors resulting in a decrease in reimbursement
192 $3,600 175 54 20 34
293 $4,800 30 17 5 12
684 $2,725 122 75 52 23
689 $4,914 210 47 27 20
872 $6,710 12 5 3 2

Part 2

In a brief recommendation to leadership (3-4 paragraphs), explain data mining. Discuss how leadership can use this information for performance improvement activities. Recommend at least one tool or technique to monitor ongoing improvements to this process: DRG accuracy.

Target Competency

REPORT facility-wide outcomes data (internally & externally)

UTILIZE data analytics for decision support, strategic initiatives, and research

EVALUATE utilization data for patterns, trends and opportunities for improvement

Attached File:
Student Country: United States (SA Pacific Standard Time)
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