Coding Review

Case Mix Index


Case Mix Index


Case Mix Index (CMI) is used as a barometer to summarize patient population and to predict the severity of illness and expected reimbursement. A higher CMI means that you can expect to receive a higher reimbursement based on the patient population. Is your facility's CMI dropping? A decrease in CMI may indicate a lack of complete documentation or inaccurate codingOur review consultants can help ensure you receive proper payment by validating the DRG assignment. Partner with HIA to replace underperforming coding vendors or do perform a focused coding audit to ensure that you are receiving proper payment. 


Our comprehensive approach

Are your coders capturing all CC/MCCs? If not, it could be negatively affecting your CMI and quality measures. In addition to reviewing CC/MCC code selections for both medical and surgical MS-DRGs, we: 

    • Investigate cases where there is a single reporting of a CC or MCC in a given time period as this can indicate a coding error or a provider documentation opportunity. 
    • Review a sudden spike or unusually high volume of MS-DRGs with CC/MCCs as this can be an indicator or an increased denial risk and can impact mortality index reporting. 
    • Evaluate outliers in the average length of stay where inconsistencies can identify coding and documentation opportunities. 

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