How Mount Sinai Health System is Confronting DRG Downgrading

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There's a national epidemic that is significantly impacting America's hospitals. It is the tyranny of DRG downgrading.

No doubt you and your facility are also struggling to comply with professional coding and billing standards while having to address the often arbitrary requirements of third-party vendors. You must adhere to legal and ethical standards of coding and billing while these auditors often impose arbitrary requirements of their own invention. The result of this current trend is that your facility's quality indicators and revenue can be adversely impacted by these standards.

Fortunately, during this upcoming timely and important webcast, you will benefit from learning how Mount Sinai Health System is addressing diagnosis-related group (DRG) downgrades, including their successes, challenges, and future goals.

Learning Objectives

From this time-sensitive webcast you will be able to...
  • Identify current trends in DRG downgrading
  • Discuss the interdepartmental process required for DRG appeals
  • Understand the roles of coding and clinical documentation improvement (CDI) professionals
  • Assess the key issue of relying on coding guidelines versus clinical indicators
  • Understand the impact of DRG downgrading
James Jones

James Jones, MD, is the senior medical director of clinical documentation and quality improvement (CDQI) at Mount Sinai Health System. Dr. Jones received his medical training at St. Luke's Roosevelt Hospital in New York City. He completed an internal medicine residency, chief resident year, fellowships in nephrology and critical care, and an administrative fellowship at the American Hospital Association in healthcare transformation, where he is currently a senior fellow. Dr. Jones joined the divisions of nephrology and critical care in 2008, advancing to associate fellowship director within the division of nephrology, and became director of both continuous renal replacement therapy and transplant donor evaluations. This was followed by a period of serving as director of medical informatics and quality initiatives for Mount Sinai St. Luke's and Mount Sinai Roosevelt. He currently is the vice president of administration at Mount Sinai West and the senior systems medical director of CDQI for the health system.