You have been reviewing documentation in your medical records department for the last week and have discovered

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You have been reviewing documentation in your medical records department for the last week and have discovered a potential issue with respect to documentation for MS-DRG 193 (Simple Pneumonia & Pleurisy w MCC) and MS-DRG 194 (Simple Pneumonia & Pleurisy w CC). You have discovered 20 cases that were coded as MS-DRG 194, when in fact these patients did have diagnosis to support the major comorbidity and complication assignment. If the hospital’s base payment rate for a case weight of 1.000 is $5,000, determine the incremental payment the hospital would have received. Assume the case weight for is 1.000 for MS-DRG 194 and 1.4378 for MS-DRG 193.

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Essentials Of Health Care Finance

ISBN: 9781284094633

8th Edition

Authors: William O. Cleverley, James O. Cleverley

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