DOCUMENTATION AND DRGS课件.ppt

DOCUMENTATION AND DRG’S DOCUMENTATION AND DRG’sA general guide How DRG’s work How they affect the provider How the provider affects them What should be documented in order to assure the most appropriate DRG for each patient: a) generally b) specifically DRG OVERVIEW DRG’s: How do they work? How do we use them? DRG’s GROUP PATIENTS WITH SIMILAR RESOURCE CONSUMPTION AND LENGTH-OF-STAY PATTERNS. THERE ARE 523 DRGs AVAILABLE. EACH DRG HAS A “RELATIVE WEIGHT.” The higher the relative weight, the greater the average resource consumption. This is used to calculate reimbursement to the hospital for DRG-based payors like Medicare (and in some states, Medicaid, Blue Cross, and others). DRG’s ESTABLISH OUR CASE MIX INDEX. This is an average of the relative weights of all of the hospital admissions being evaluated. This in turn is an indicator of the severity / complexity of patient population. DRG’s ARE USED FOR: determining hospital reimbursement, budgeting, managed care contracts, economic profiling, physician profiling, case management, residency program justification, and more. DRG: DIAGNOSIS-RELATED GROUPWhat affects the DRG assigned for the patient? PRINCIPAL DIAGNOSIS COMPLICATIONS CO-MORBIDITIES PRINCIPAL PROCEDURE AGE OF PATIENT DISCHARGE DISPOSITION DEFINITIONS Principal Diagnosis: The condition, established after study, to be chiefly responsible for causing the admission of the patient to the hospital. Complication: Any condition that arises during the hospital stay. Co-morbidity: Any pre-existing or chronic condition that the patient already has upon admission to the hospital. Principal Procedure: A procedure performed for definitive treatment rather than for exploratory or diagnostic purposes, or that was necessary to treat a complication. The principal procedure is usually related to the principal diagnosis. PRINCIPAL DIAGNOSIS:What documentation is needed? THIS SHOULD BE AS SPECIFIC AS POSSIB