CASE: High-Risk Medicare-Severity Diagnosis-Related Groups (MS-DRGs)

You are the coding supervisor at a 250-bed acute care hospital. The facility averages about 1050 discharges per month. About 41% of the discharges are Medicare. You have been given the responsibility of ensuring that there are no problems with the OIG's MS-DRG target areas.

1. On the www.pepperresources.com website, identify the current target area MS-DRGs for improper reimbursement.

2. Create a plan for monitoring these MS-DRGs. In this plan include at least:

· The types of monitoring to be performed
· Sample size to monitor
· Frequency of the monitoring
· Case selection criteria
· Documentation of monitoring activities
· A format for reporting the monitoring results
· A corrective action plan.