You are the Coding Manager at TCC Hospital and you are conducting an internal DRG Accuracy audit of cases coded to MS-DRG 195 Simple Pneumonia without an MCC/CC. You were asked to conduct this audit because DRG 195 was one of many that appeared on the most recent CMS Comprehensive Error Rate Testing (CERT) Program report with upcoding errors, overpayment, and other improper payments. The results of your audit need to be reported to the executive board by next week.

Answer rating: 100% (QA)

As the Coding Manager at TCC Hospital you have been assigned to conduct an internal DRG Accuracy audit specifically focusing on cases coded to MSDRG 195 which represents Simple Pneumonia without a Maj... View the full answer