Complex DRG audits reveal CDI target areas

Connolly Healthcare, CMS’ recovery audit contractor (RAC) for Region C, announced its first targets for complex review in December 2009. Connolly’s list of 24 DRGs is the first published, so it provides a good preview of what other RACs may target. The reviews were expected to begin in January.

The release of the targeted MS-DRGs “is and isn’t big news,” says Lynne A. Spryszak, RN, CCDS, CPC-A, manager at Precyse Solutions, LLC, in Wayne, PA. The Program for Evaluating Payment Patterns Electronic Report, the Office of Inspector General’s annual Work Plan, and even Ingenix’s DRG Expert offer clues to suspect DRGs of which CDI specialists should be wary.

“CDI specialists should be aware of some of these items since it’s not the first time they’ve been targeted,” Spryszak says. “But the release of Connolly’s list should add motivation to existing CDI programs’ concurrent review practices.”