Inpatient Records

Inpatient Coding

Codebusters has been providing inpatient coding services to complex acute care hospitals since the inception of the company in 2000.

Accurate DRG submittals are fundamental to meeting compliance requirements and achieving top line revenue for hospitals’ highest paid service lines.

  • Immediate access to hundreds of fully vetted inpatient coders
  • On-demand coders are always available, putting an end to backlogs forever
  • 100% accuracy guaranteed
  • Continuous auditing and transparent reporting
  • Proprietary workforce management platform
  • Full department or specialty outsourcing
  • Interim staffing and MSP Program support
  • Reduce claim denials, increase CMI, improve AR
  • Eliminate retention/recruiting struggles

Inpatient encounters represent the highest dollar claims for hospitals. Having access to expert coders who can work with physicians to ensure documentation support code assignment can make or break a hospital in this era ICD-10. Each coder/auditor on our team undergoes a thorough background check, proof-of-skills testing, an interview with one of our Inpatient Coding Supervisors, and of course be certified with the CCS from AHIMA. In certain circumstances, we will accept RHITs provided they have expert knowledge and over 4 years of experience. Coders are kept up to date on the latest coding changes and constantly audited to ensure correctness. In fact, we guarantee the billing accuracy of the codes we assign. We fully manage and train our coders in as true partnership solution provider.

The coding requirements for inpatient encounters contain many compliance challenges, especially with the various payment methodologies now available. An experienced inpatient coder must know when a stay will be paid using the MS-DRG calculation, the APR-DRG calculation, or the Hierarchical Condition Categories used for Medicare and Medicaid managed care plans.

There is also the challenge of properly coding procedures in ICD-10-PCS. Our coders provide documentation feedback, following query guidelines established by the hospital, in order to assist the client in full revenue capture.

Codebusters guarantees the accuracy of our codes. Any errors discovered will be corrected immediately without charge. If warranted, these errors and corrections will be made a regular part of compliance trainings. We ensure coders take part in regular coding update educational sessions, and maintain their AHIMA  credentials.

3 Medical coders looking at charts

Inpatient Coding Reviews

Outside Coding Compliance Audits are a fundamental part of a compliance program.  Hospitals should consider performing coding reviews around coding changes no less than twice per year, though having a partner in place for smaller bi-weekly pre-billing audits will ensure far more accuracy. This continuous auditing can immediately identify patterns of poor documentation or coding. Quarterly or annual reviews should be performed on a retrospective basis.

Codebusters’ Inpatient Records Review verifies compliance with payer requirements and government regulations. The inpatient audit examines the following:

  • Completeness and clarity of the documentation as required by the payer
  • ICD-10-CM diagnosis and procedure code assignment
  • Present on Admission (POA) Indicators
  • MS-DRG, APR-DRG,  and HCC validations (depending on the payer)
  • Major Complication and Comorbidities verification (MCC’s & CC’s)
  • Discharge Disposition validation
  • Accuracy of UB-04 billing claims by making sure codes are crossing over correctly.

In the final report, coding errors will be discussed and coding guidelines explained.  Problems with physician query and documentation will be reported and can be discussed with physicians and coders through video chat or in person.  Training materials will be recommended in order to prevent future errors.  Recommendations will also be made regarding coding processes and on-going monitoring to identify errors in a timely manner.

Components of the Inpatient Review:

  • Verifying that the principal diagnosis is correct   
  • Analyzing the chart for Complications and Comorbidities (CCs & MCCs) Verification
  • Analyze the Physician Query process
  • Identify Documentation Concerns
  • ICD-10-CM/PCS Code Verification
  • MS-DRG & APR-DRG Validations
  • POA (Present On Admission) Validation
  • Discharge Disposition Validation
  • Admission Criteria
  • Provide Education
  • Case Mix Analysis and/or Review

3 happy medical staff looking at charts

General Audit Topics:

  • High-Revenue RAC Targets
  • OIG Work Plan
  • Fraud Alerts
  • Top 10-25 Surgeries
  • Top 10-25 MS-DRGs
  • High-volume, high-risk procedures
  • Top 10-25 denials
  • Top 10-25 services provided
  • Inpatient Outliers
  • Consecutive Inpatient Stays
  • Medical Necessity

Sample Focused Coding Reviews:

  • Medicare Administrative Contractor (MAC) denials      
  • Surgical Complications
  • Obstetrical Complications
  • Error MS-DRGs
  • Accurate ICD-10 procedural coding
  • Sepsis and septic shock sequencing
  • OIG-identified paired/families of MS-DRGs
  • Recent issues identified by external review agencies and professional journals