Question
Your hospital is reviewing its DRG coding patterns for Medicare. It has focused on two DRGs: 640 (Nutritional and Misc Metabolic Disorders w/ MCC) and
Your hospital is reviewing its DRG coding patterns for Medicare. It has focused on two DRGs: 640 (Nutritional and Misc Metabolic Disorders w/ MCC) and 641 (Nutritional and Metabolic Disorders w/o CC). There were 100 patients assigned to these two DR Gs: 50 to 640 and 50 to 641 . National averages suggest that 85 should have been assigned to DRG 640 and 15 to DRG 641 . Assuming an average payment of $6,000 per DRG with a case weight of 1.0, how much lost payment from Medicare may be resulting from poor coding and documentation? Use case weight values from Appendix 3-A.
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