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Successfully Managing DRG Mismatches


The old saying says it best – two heads are better than one. That’s the crux of DRG reconciliation – the process whereby an organization compares the diagnosis-related group (DRG) code identified by clinical documentation improvement (CDI) teams with the DRG code applied by coding staff to identify discrepancies. While clinical documentation improvement (CDI) and coding teams don’t always come to the same conclusion, inconsistencies can help identify educational opportunities for both teams. In addition, the auditing and reconciliation process are key to quality improvement and revenue integrity.

Collaboration is Key
When it comes to identifying, managing and reconciling DRG mismatches, it’s all about collaboration. Some organizations report friction between coding and clinical documentation improvement (CDI) teams and even providers, but it doesn’t have to be this way. Here are some tips for successfully managing DRG mismatch issues in your organization.

• Let technology help. Organizations that use computer-assisted coding (CAC) allow coding and clinical documentation improvement (CDI) teams to work together on a shared platform. This way, coders can use the CDI team’s working diagnosis as a starting point – which can save time, improve productivity and reduce the need to hold bills while reconciliation is ongoing.

• Employ a CDI/Coding liaison. Oftentimes, a neutral party can help improve coordination, communication and collaboration among clinical documentation improvement (CDI) and coding teams. By employing a liaison to help facilitate communication, ongoing education and process improvement, organizations will often see greater camaraderie among all parties.

• Focus on collaborative reconciliation. While teams may be dispersed in multiple office locations, it’s important to maintain a collaborative process where teams can communicate openly. Employ technology to allow remote parties to participate fully by using video calls where shared screens can be viewed by all participants for greater engagement.

• Host ongoing educational programs. While reconciliation can be a process that prompts disagreement, education lends itself more to shared learning, fruitful discussion and camaraderie. Organizations that provide routine/ongoing training and education programs for clinical documentation improvement (CDI) and coding teams will benefit from greater collaboration that comes with getting to know one another outside of the reconciliation process.

• Know when enough is enough. Reconciliation can be an exhausting process – so it’s important to know when enough is enough. Limit your reconciliation sessions to no more than three hours – and come to consensus on when it’s time to query the provider for a final determination.

• Track your performance. Reducing mismatches is a key performance indicator that should be tracked. If you’re routinely tracking your rates and they start trending up – it’s time for a comprehensive evaluation of what is causing the uptick in mismatches. Conversely, a reduction in mismatches is an opportunity for shared celebration among clinical documentation improvement (CDI) and coding teams.

Much like medicine, coding is not an exact science. That’s why taking a collaborative approach – and one of continuous performance improvement is critical for your organization’s compliance and revenue integrity. Oftentimes, organizations can see real benefits in reducing their DRG mismatch rates by partnering with an outsourcing provider for either coding and/or clinical documentation improvement (CDI).

GeBBS Healthcare Solutions offers a wide range of coding solutions and employs more than 2,000 certified coders and clinical documentation improvement (CDI) specialists. To learn more, about our technology enabled solutions, visit us at gebbs.com or schedule your consultation with a GeBBS Solutions Specialist here.

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