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week 4 case study

week 4 case study

We also reviewed HCFA’s current instructions to the Medicare PROs. We found no instructions to the PROs advising them to perform any routine monitoring and analysis of DRG coding, despite the fact that PROs already have a complete set of inpatient billing data provided to them by HCFA. In fact, HCFA staff told us that the PROs were instructed not to do “coding projects” within their current contract. We did find that PROs are involved in sporadic activity around DRG oversight; however, this activity often is in support of an OIG investigation. (Department of Health and Human Services, Office of Inspector General, 1999, pp. 1–4)

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