KEY ASSESSMENT: DRG Data Analysis and Decision Making:

Assessment Instructions: You are the Coding Manager for a mid-size acute care hospital. Based on historical data, the hospital has decided to hold and review all cases that group to the following DRGs prior to claim submission:

• 192: Chronic obstructive pulmonary disease w/o CC/MCC
• 293: Heart failure and shock w/o CC/MCC
• 684: Renal failure w/o CC/MCC
• 689: Kidney and urinary tract infections w/ MCC
• 872: Septicemia w/o MV 96+ hours w/o MCC

It is your responsibility to review and present the quarterly audit results to the HIM Director. Analyze the following audit results. The facility averages 2,500 discharges per quarter.

Part 1

Prepare a decision support (simulated) dashboard using the data on the table below that will summarize/compare individual and cumulative DRG results. Consider what information would be pertinent to leadership for decision-making and strategic planning and the best way to display this data - in a dashboard format.

DRG	Total Reimbursement per Case	Number of Discharges	Cases with DRG/Coding Errors	# Cases with errors resulting in an increase in reimbursement	# Cases with errors resulting in a decrease in reimbursement
192	$3,600	175	54	20	34
293	$4,800	30	17	5	12
684	$2,725	122	75	52	23
689	$4,914	210	47	27	20
872	$6,710	12	5	3	2

Part 2

In a brief recommendation to leadership (3-4 paragraphs), explain data mining. Discuss how leadership can use this information for performance improvement activities. Recommend at least one tool or technique to monitor ongoing improvements to this process: DRG accuracy.