1. RECOVERY STRATEGY Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton & Associates, LLC Erin, Tennessee 37061 February 18, 2010

2. 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)

3. FINDINGS  Total Records: 148  Pre-review CMI – 1.2679  Post-review CMI – 1.3420 Total Changes – 61  Decrease – 17  Increase – 44  Cumulative change/chart -.0741  Total cumulative change – 10.9668  Total Revenue Enhancement - $60,317.75

4. IMPACT  Recovery Audit Contractor (RAC) Impact 11% of Total number of records reviewed Weight Decrease – 6.3375 Revenue - $34,850.00  Total Impact 41% of Total number of records reviewed Total Weight Change – 17.3043 Revenue Change - $95,200.00

5. UTI/SEPSIS  690 – Kidney & urinary tract infections w/o MCC – Wt..7708  700 – Other kidney & UTI infections w/o CC/MCC – Wt..6533  699 – Other kidney & UTI infections w CC – Wt..9518  698 – Other kidney & UTI Infections W MCC – Wt. 1.4877  872 – Septicemia w/o MV 96+ hrs w/o MCC – Wt. 1.1155  871 – Septicemia w/o MV 96+ hrs w MCC – Wt. 1.8437  870 – Septicemia w MV 96+ hours – Wt. 5.8007

6. COPD Pneumonia Respiratory failure  203 – Bronchitis & asthma w/o CC/MCC – Wt..6055  202 – Bronchitis & asthma w CC/MCC – Wt..8374  192 – COPD w/o CC/MCC – Wt..7175  191 – COPD w CC -.9622  190 – COPD w MCC – 1.2076  195 – Simple Pneumonia & Pleurisy w/o CC/MCC – Wt..7095  194 – Simple Pneumonia & Pleurisy w CC – Wt..9976  193 – Simple Pneumonia & Pleurisy w MCC Wt. 1.4378  189 – Pulmonary edema & respiratory failure – Wt. 1.3455

7. COPD Pneumonia Respiratory Failure  179 – Respiratory infections & inflammations w/o CC/MCC Wt. 1.2754  178 – Respiratory infections & inflammations w cc – Wt. 1.5636  177 – Respiratory infections & inflammations w MCC – 1.8444  208 – Respiratory system diagnosis w ventilator support < 96 hours – Wt. 2.2463  207 – Respiratory system diagnosis w ventilator support 96+ hours – Wt. 5.1231

8. Congestive Heart Failure  DRG 291 – Heart Failure and Shock with MCC – Wt. 1.4609  DRG 292 – Heart Failure and Shock with CC – Wt..9740  DRG 293 – Heart Failure and Shock w/o CC/MCC – Wt..6940

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

10. 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

11. TODAY’S HOSPITAL ENVIRONMENT MANAGE IT PROVE IT