Inpatient Facility Coding & Compliance Alert

Question: I am preparing for the audit of my facility. I heard that I can use the available MS-DRG data of the facility for utilization review. How do I do that?

Florida Subscriber

Answer: If you have the patience of going through the data, MS-DRGs can reveal a wealth of information about your facility. MS-DRG data is available for the specific hospitals relative to their billings.  Hospital billing systems can generate reports by MS-DRG along with other types of factors (e.g., payer, location, provider, etc.) You can:

• Examine utilization patterns among similar groups of patients to study variances and problem areas.
• Examine variations in practice patterns amongst different providers for similar patient groups.
• Check the overutilization of ancillary services, if any, benchmarking it against the expected resource utilization by a given MS-DRG.
• Determine the top ten MS-DRGs managed by your facility, and review them for appropriateness of the services provided.
• Your finance team can use the data for hospital cost analysis, monitoring revenue in a timely fashion to detect any potential problems.
• Additionally, the data can reveal trends in patient requirements that can be your idea generators in planning for new services and expanding certain services that are “in demand.”