Article | March 21, 2022

Make the Most of DRG/RUG/DME by Coding Correctly: Improve Quality While Increasing Productivity

The Current Environment

Hospitals continue to face the challenges from the MACs, RACs, and the OIG on whether hospitals have submitted claims in accordance with many regulations and criteria—and whether they have been reimbursed appropriately for costs associated with the new services and technologies. Focus is on “high acuity” patients, admission criteria, and re-admissions. The need is to anticipate regulatory changes and develop strategies to comply with CMS.

All of these health care providers—Hospitals, Nursing Homes, Home Healthcare Organizations, Durable Medical Equipment Companies who bill Medicare—are going to be subject to audits to review improper payments.

According to the OIG, skilled nursing facilities (SNFs) increasingly billed Medicare for higher paying resource utilization groups (RUGs), while beneficiary characteristics remained largely unchanged. Long Term Acute Care is subject to increasing regulations, and financial reimbursement changes.

While many of these areas are highly dependent on the need to improve physician documentation, the challenge for many is the increased need for the unavailable experienced coder. To meet this growing need, any review, if appropriate, will include training of the coders to improve performance.

Our Approach to Providing Assistance

Kohler HealthCare Consulting offers experienced health care professionals with the necessary tools to assist hospitals in evaluating, measuring and monitoring processes, procedures while complying with the governing regulations. Because of our hands-on experience we understand and can help you work through the challenges and the hurdles faced by your facility.

What Can We Offer Your Hospital?

  • Coding and Documentation Audits
  • Medicare/Billing Claims Audits
  • MS-DRG Validation
  • LTAC-DRG Validation
  • RUG Validation
  • Medical Necessity Documentation Reviews
  • Inpatient Short Stay and Observation Reviews
  • Regulation/Compliance Policy and Guidelines Reviews
  • Implementation of Coding, HIM and CDI Best Practice