3 sub grouping based on the precise surgical

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3. Sub-grouping based on the precise surgical procedure formed or, for medical patients, the precise condition designated as the principal diagnosis. 4. Final DRG assignment will consider age and/or the presence of a complicating condition or co-morbidity. The "Casemix Grouper" provides an "Optimiser" module that allows the hospital to view the DRG income effect of each medical diagnosis, before determining the principal diagnosis. Using the Optimiser, the highest legitimate income entitlements are realised .
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An Introduction to DRG's TC Health Administration © 10 DRG assignment on admission A key determinant of profit or loss is patient length of stay. The DRG income is based on an average length of stay and if average length of stay is exceeded the extra days do not normally attract additional payment (exceptions exist). Under DRG financing, delays in completing the medical record have serious consequences. Not only can payment denial result through failure to advise completed production but control over cash flow is impeded and quality assurance review can be delayed because the database is incomplete. It is not possible to monitor the LOS after the patient is discharged. If a tentative DRG is assigned on admission then interactive reporting can enable review by clinical staff. As patient treatment advances then new diagnosis appear and a revised DRG is assigned with a reasonably reliable DRG length of stay evident. The following benefits accrue from assigning the DRG on admission: head2right By inter active monitoring of LOS, the hospital is able to avoid "unpaid days" and inappropriate early discharge head2right Discharge planning can commence on admission and clinical diagnostic information is available to support that planning; head2right The principal diagnosis is more readily available at discharge and cash flow improves when the invoice can be given to the patient as they leave hospital - DRG income entitlement is known; head2right As the inpatient coding is completed sooner, then quality assurance data (e.g. infection control) can be extracted and examined interactively and/or remotely - daily if required.
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An Introduction to DRG's TC Health Administration © 11 The Cost Effect of Inadequate Documentation Example 1 A 26 year old patient admitted for treatment of a compound fracture of the radius and ulna, upper proximal epiphysis. Fracture treated by an open wound reduction with internal fixation. The responsible doctor records the diagnosis and treatment as: Fracture of Arm Reduction Because of the lack of detail the episode would be coded with: T100 Ill defined fracture of upper limb, elbow, forearm 4736300 Closed reduction of fracture without internal fixation, arm, NOS The resulting AR-DRG assignment is: DRG I75 Average length of stay 1.8400 days Income per patient = Cost weight 0.5300 x Benchmark price (say $A1,500.00) = $A795.00 Recording the diagnosis and procedure accurately results in ….
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  • Fall '18
  • Diagnosis-related group, DRG

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