At the end of this online enduring material, participants should be able to:

• Explain how ICD-10 codes and DRG assignments are being used to determine severity of illness (SOI) and risk of mortality (ROM) scores, and how these are used for determining severity-adjusted clinical outcomes (O/E ratios), such as mortality, length of stay (LOS), and readmission rates (i.e., Value-Based Purchasing initiatives)
• Describe that individual providers are now under the same level of scrutiny as hospitals have been, by virtue of MACRA/MIPS (Merit-Based Incentive Program) initiatives
• Discuss how dependent hospital coders are on appropriate and specific provider documentation, both wording and clinical validation, for accurate determinations of ICD-10 codes, and how a CDI program is designed to help providers "get it right"
• Review how hospital-acquired conditions (HACs) and patient safety indicators (PSIs) are determined by coders, how provider documentation can lead to inaccuracies in this determination, with subsequent quality and safety determinations
• Generalize the key factors in documentation for medical necessity determinations such as inpatient versus observation status for medical and surgical patients, as well as to help prevent denials, as medical records become more scrutinized