RECOVERY STRATEGY Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton & Associates, LLC Erin, Tennessee February 18, 2010

Pre-RAC Audits SHIP HOSPITALS – NON-SHIP HOSPITALS  Sample – 30 Records October 2007 – Present Focused DRG List  Method of Selection – Selective Focus RAC audit list Review report utilizing All ICD-9-CM codes assigned Length of Stay Secondary codes assigned Procedures performed (if applicable)

FINDINGS  Total Records: 148  Pre-review CMI –  Post-review CMI – Total Changes – 61  Decrease – 17  Increase – 44  Cumulative change/chart  Total cumulative change –  Total Revenue Enhancement - $60,317.75

IMPACT  Recovery Audit Contractor (RAC) Impact 11% of Total number of records reviewed Weight Decrease – Revenue - $34,  Total Impact 41% of Total number of records reviewed Total Weight Change – Revenue Change - $95,200.00

UTI/SEPSIS  690 – Kidney & urinary tract infections w/o MCC – Wt  700 – Other kidney & UTI infections w/o CC/MCC – Wt  699 – Other kidney & UTI infections w CC – Wt  698 – Other kidney & UTI Infections W MCC – Wt  872 – Septicemia w/o MV 96+ hrs w/o MCC – Wt  871 – Septicemia w/o MV 96+ hrs w MCC – Wt  870 – Septicemia w MV 96+ hours – Wt

COPD Pneumonia Respiratory failure  203 – Bronchitis & asthma w/o CC/MCC – Wt  202 – Bronchitis & asthma w CC/MCC – Wt  192 – COPD w/o CC/MCC – Wt  191 – COPD w CC  190 – COPD w MCC –  195 – Simple Pneumonia & Pleurisy w/o CC/MCC – Wt  194 – Simple Pneumonia & Pleurisy w CC – Wt  193 – Simple Pneumonia & Pleurisy w MCC Wt  189 – Pulmonary edema & respiratory failure – Wt

COPD Pneumonia Respiratory Failure  179 – Respiratory infections & inflammations w/o CC/MCC Wt  178 – Respiratory infections & inflammations w cc – Wt  177 – Respiratory infections & inflammations w MCC –  208 – Respiratory system diagnosis w ventilator support < 96 hours – Wt  207 – Respiratory system diagnosis w ventilator support 96+ hours – Wt

Congestive Heart Failure  DRG 291 – Heart Failure and Shock with MCC – Wt  DRG 292 – Heart Failure and Shock with CC – Wt  DRG 293 – Heart Failure and Shock w/o CC/MCC – Wt..6940

HomeTown Health Solution  EDUCATION Coding Staff Case Management/Documentation Specialty Staff Ancillary Department Managers Hospital Management Physicians

Documentation Specialty Program  Develop Case Management/Documentation Specialty Program  Establish Top 10 DRG’s for facility  Develop hierarchy for Each DRG Set  Query Physicians concurrently  Make sure documentation is present before discharge  Manage LOS for Transfer DRG’S  Compare Coder DRG Assignment with Documentation Specialty DRG Assignment as an educational tool  Monitor Case Mix Index (CMI) as patterns develop

TODAY’S HOSPITAL ENVIRONMENT MANAGE IT PROVE IT