Case Study Challenge

Swindon Clinical Commissioning Group (CCG) appointed maxwell stanley to determine the accuracy of the clinical coding of procedure complexity and co-morbidities.

Case Study Approach

Our PbR experts completed in-depth analysis in order to validate the area of concern, undertaking HRG trend analysis and national benchmarking of procedure complexities and co-morbidities.

Data analysis identified activity cohorts requiring a manual review of the data by our qualified Clinical Coding Auditors who subsequently examined individual admissions to isolate potential error trends.

Our PbR experts also analysed the marginal variances between complexities of procedures, as classified within the HRG Local Payment Grouper, to identify those admissions most susceptible to HRG variances.

At this stage, our client was presented with our potential hypotheses, initial activity and financial impact analysis along with our recommendations regarding continuing the investigation with a targeted case note audit.

Following our recommendation, a targeted case note audit was completed by our qualified Clinical Coding Auditors, providing evidence to support our initial hypothesis and confirm any identified potential error trends.

Our Analysts compiled all case note review results and analysed activity and financial impact, using appropriate extrapolation methods.

Case Study Outcome

A succinct Challenge Rationale Report was produced containing:

  • Data analysis supporting challenge
  • Case Note Audit method and results
  • Conclusions of maxwell stanley investigation
  • Activity and financial impact analysis
  • Recommendations for year-end settlements and establishing accurate contract baselines