Norwood MS-DRG audit results in substantial DNFB reduction, missed revenue opportunities

Even with the rapid growth of risk adjusted payments, Medicare Severity DRGs (MS-DRGs) remain the principal reimbursement mechanism for most healthcare organizations.

 

But despite their relative maturity there is always room to improve MS-DRG assignment. Missed complications/comorbidities (CC) and major CCs, inaccurate principal diagnosis assignment, and non-specific/symptom DRGs lead to underreported severity of illness. Which in turn results in negative profit margins and even closures of vulnerable community hospitals.

 

The problem

 

A healthcare organization with hospitals in New Hampshire and Pennsylvania had a looming sense that they were trailing their peers in comparable inpatient reimbursement. 

 

In addition, the pressure of a growing discharged not final billed (DNFB) backlog added fuel to the fire as harried HIM staff couldn’t spend the necessary time to thoroughly code each chart.

 

The Solution

 

This healthcare organization partnered with Norwood for coding expertise and managed services support. Our team of clinically credentialed CDI specialists and inpatient coding professionals performed a pair of MS-DRG projects with slightly different scopes of work.

 

Project 1: Audit of 584 inpatient cases in two hospitals.

 

Results:

 

-Identified $294k in missed revenue

-Impact identified was $584 per case
-40% of cases revealed opportunity for added specificity

 

Project 2: Audit of 70 inpatient MS-DRG cases in one hospital, with addition of leveraged inpatient coding expertise to decrease backlog of 300+ pending cases.

 

Results:

 

-Decreased DNFB by millions of dollars in several weeks
-Identified $41k in missed revenue opportunities across 70 cases 

-47% of cases revealed opportunity for added specificity

 

Norwood is your Solution 

 

Norwood is not just a staffing company—we solve your organization’s problems. 

 

How do we do it? With a unique blend of consulting and managed services. We meet your needs, where you are, with the customized solution that fits your organization.  

 

Learn more about our unique set of solutions at https://www.norwood.com/solutions/  

 

Contact us at solutions@norwood.com.