• 1. Select two DRGs of interest to you that could be easily miscoded for each other. Calculate the Medicare hospital payments for each DRG under IPPS. Compare the payment difference. 
• 2. Select two CPT codes of interest to you that could be easily miscoded for each other. Determine the related RVUs and GPCIs, and calculate the Medicare physician payment or each code under RBRVS. Compare the payment difference. 
• 3. Identify potential omitted, understated or overstated wording in the Medical Record that could result in miscoding. (E.g., if it was a surgery, did you remember to state that you used sutures, or did you assume that would simply be understood? Was it removal of a mole, or an irritated mole? etc.) 
• 4. Discuss the ethics of proper medical record documentation. (E.g., if no sutures are recorded for a surgery, could malpractice liability be construed?) 
• 5. Discuss the specific Medicare fraud & abuse penalties associated with upcoded services.

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1 The two key DRGs of interest to me include bacterial and tuberculosis infections of nervous system with mcc and bacterial and tuberculosis infections of nervous system without ccmcc It is undisputab... View the full answer