Below is a link to an Additional Documentation Request Letter (ADR) letter from Connolly to a hospital in Georgia. It only requests 5 records, but is only the first they’ve received, and is dated Feb 25, 2010.
Download this letter, HERE.
Here are a few things we’ve noted about the letter:
DRG Validations for the following MSDRGs –
- MSDRG 981 – OR Procedure unrelated – RW 5.04, Rank 134, ALOS 14.6 – claim shows 7 day stay.
- MSDRG 386 – Inflammatory Bowel Disease – RW 1.04, Rank 343, ALOS 5.4 – shows 6 day stay.
- MSDRG 574 – Skin Graft &/or Debridement – RW 1.91, Rank 352, ALOS 8.9 – shows 5 day stay.
- MSDRG 574 – Skin Graft &/or Debridement – RW 1.91, Rank 352, ALOS 8.9 – shows 4 day stay.
- MSDRG 357 – Other Digestion System OR Procedure – RW 2.12, Rank 468, ALOS 7.7 – shows 3 day stay.
Abbreviations used, above:
- OR = Operating Room
- RW = Relative Weight for reiumbursement
- Rank = nationwide rank, reported by CMS, by number of discharges in FY09 (#1 = highest)
- ALOS = Average Length of Stay in days
In the letter, note that the Rationale for each DRG Validation mentions that “the RAC Demonstration … found an overwhelming majority of errors in assignment… resulting in overpayments to hospitals.”
The letter then goes on to state: “The RAC identified errors in the data that could be traced to the hospitals’ medical record practice. An analysis of your billing data indicates that a potential aberrant billing practice may exist for this DRG.”
Interesting wording… note the use of “hospitals‘” (plural); and “your billing data” — the letter does not make clear what analysis the RAC really did.
