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Year 2 HWDRG Validation Reviews

Published on 

Wednesday, March 13, 2024

 | Coding 
 | Case Management 
 | Documentation 

Did You Know?

In the February 2024 edition of The Livanta Claims Review Advisor, Livanta reported findings from their second year of higher-weighted diagnosis related groups (HWDRG) validation reviews completed from November 1, 2022 through October 31, 2023. They note in the newsletter that these types of reviews “involve validation of codes on the claim by credentialed coding auditors and clinical review by board-certified practicing physicians as appropriate.”

 

Coding auditors utilize official coding guidelines, the American Hospital Association (AHA) Coding Clinics, and other authoritative coding references to complete their DRG validation reviews.  

 

Why It Matters?

When a hospital submits a record for a HWDRG, the review may also include a review to determine if the documentation also supported the medical necessity of an inpatient admission. The following table highlights a compare of Livanta’s Year One and Year Two review results.

 

Overall Findings

Year 1

Year 2

Number

Percent

Number

Percent

Approved

47,615

88%

50,928

88%

DRG Changes

6,550

12%

6,603

11%

Admission Denials (Medical Necessity Errors)

86

<1%

619

1%

Total Claims Reviewed

54,251

100%

58,150

100%

 

Additional information that you will find in the Year 2 Review Results includes:

  • Findings by CMS Region,
  • Code Level Changes,
  • Reasons for DRG Change by Livanta,
  • The Top 10 DRGs that resulted in Livanta reversing the HWDRG to the previously billed DRG,
  • Top Denial Reasons,
  • Top HWDRGs Changed,
  • Information on how to contact Livanta if your hospital is interested in focused training on specific coding topics,
  • General information about Livanta, and
  • An email that you can use to send questions to Livanta.

 

What Can You Do?

 

Resources

Livanta Claim Review Services, First Year Review Findings, Higher Weighted Diagnosis Related Group (HWDRG) Reviews slide deck: https://www.livantaqio.cms.gov/en/ClaimReview/files/Claim-Review-Services-Year1-Findings-HWDRG_012423.pdf

 

The Livanta Claims Review Advisor, Volume 1, Issue 24, February 2024, Higher Weighted Diagnosis Related Groups (HWDRG) Validation – Second Year Review Findings: https://myemail.constantcontact.com/Higher-Weighted-Diagnosis-Related-Groups--HWDRG--Validation---Second-Year-Review-Findings.html?soid=1132747942080&aid=13uxYINEqE8

 

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.