MS-DRG Clinical Documentation Improvement Program Overview

Ease your MS-DRG transition with improved documentation

The biggest change to Medicare’s DRG payment system in 24 years is expected to come October 1, 2007 with the implementation of severity-adjusted DRGs, a methodology to help Medicare better classify and categorize patient illness. OptumInsight offers a clinical documentation improvement program specifically designed to help hospitals operate efficiently under this new system.

Find out what MS-DRGs mean to you—and how to respond

• Identify how MS-DRGs influence your revenue cycle
• Determine where to focus resources to mitigate risk
• Compare your facility against a peer group using key indicators

Impact assessment

OptumInsight provides data and consulting solutions to help hospitals ascertain the financial impact of the transition to MS-DRGs, identify financial risk by service line, and determine how to drive coding improvement. The Inpatient MS-DRG Impact Reports identify areas where a hospital’s diagnosis coding may affect the severity level of the DRG.

Data quality and operational assessment

Inpatient data quality reviews will determine coding accuracy as it relates to over- and under-coding, appropriateness of diagnostic and procedural sequencing, and compliance with internal policies and external rules and regulations. OptumInsight also will incorporate an onsite review of current coding and documentation processes and procedures.

Education and monitoring

The program includes materials and educational sessions to inform nurses, coders, physicians, and management on how to properly incorporate MS-DRGs into case management. OptumInsight provides follow-up observation three months after the program implementation to determine whether your hospital could benefit from additional education or modifications.