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Examine the relationship between medical documentation, the severity of illness, hospital-acquired conditions, present on admission indicators, and case mix.

Examine the relationship between medical documentation, the severity of illness, hospital-acquired conditions, present on admission indicators, and case mix.

Based on your review of the POA and case-mix information below, write a 2-3page recommendations report to:

  • Examine the relationship between medical documentation, the severity of illness, hospital-acquired conditions, present on admission indicators, and case mix.
    • Provide specific examples to support your examination, based on POA and case-mix information for Independence hospital.
  • Recommendations that may impact revenue and reimbursement, based on your assessment of the information.
  • Recommendations to educate physicians on documentation standards.
  • Recommendations to educate coders on how to work with physicians with the documentation process.

Present on Admission

Under the Hospital-Acquired Conditions provision, the Secretary of Health and Human Services has designated several conditions that, when acquired during a hospital admission, have the potential to reduce payment. One of the conditions is Pressure Ulcers (ICD-10-CML89.X) codes. To identify if the pressure ulcer was present when the patient was admitted or was acquired during the hospital stay, the hospital must report a present on admission code for each diagnosis on the billing form.

You are working with the coding manager at Independence Hospital. The coders have been asked to apply the present on admission indicator code. The coding manager has collected data over the past six months and it is clear from the data, that there is an issue with either the documentation of pressure ulcers, assignment of the POA indicator, or the quality of care.

POA Report for Pressure Ulcers (L89.X) October – March
POA Code Description Volume
Y Yes, present on admission 15
N No, not present on admission 30
U Unknown, insufficient documentation 45
W Clinically undetermined 3
1 Exempt from POA reporting 0

Case Mix

The Case mix index (CMI) is the average weight of a healthcare facility’s diagnosis-related groups (MS-DRG). The higher a facility’s CMI, the greater the number of high-cost services the facility performs. The more high-cost services performed, the more revenue.

Steps to Calculate CMI:

1. Multiply the relative weight of each MS-DRG by the number of discharges for each MS-DRG.

2. Sum of all weights is the case-mix

3. Divide the case-mix by the total number of patients.

MS-DRG MS-DRG WEIGHT # OF DISCHARGES
Renal failure w MCC 682 2.0 10
Renal failure w CC     683 1.5 10
Renal failure w/o CC/MCC 684 1.0 10

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