Casemix, Clinical Coding & DRG-Based Funding Training Course

Course Overview

Learning Objectives

• Explain casemix classification principles and their role in hospital funding
• Apply ICD-10-AM, ACHI, and Australian Coding Standards principles to coding governance
• Analyze AR-DRG grouping logic from principal diagnosis to complexity splits
• Interpret how diagnoses, interventions, and complications affect DRG assignment
• Understand how cost weights are derived from patient-level costing data
• Calculate DRG-based payments using cost weights, base rates, and outlier rules
• Calculate and interpret casemix indices for hospitals and specialties
• Design risk-based coding audits with clear sampling methods and error measures
• Detect coding patterns associated with upcoding, undercoding, and DRG creep
• Assess how DRG-based funding changes hospital budgets, incentives, and behavior
• Use casemix data to benchmark efficiency, length of stay, and resource use
• Develop a coding governance and casemix performance framework

Who Should Attend

Learning Outcomes

• Explain how casemix classification links coded clinical activity to hospital funding
• Apply ICD-10-AM, ACHI, and coding standard principles within a coding governance framework
• Trace the grouping path of an episode from MDC to final DRG
• Evaluate how diagnosis sequencing and complexity affect DRG assignment
• Interpret cost weights, base rates, and outlier rules in DRG payments
• Calculate casemix indices and casemix-adjusted performance measures
• Benchmark length of stay and cost by DRG across units and hospitals
• Plan and conduct risk-based clinical coding audits
• Quantify the financial effect of coding errors and DRG changes
• Recognize indicators of upcoding, undercoding, and DRG creep
• Assess the budget and behavioral effects of DRG-based funding models
• Develop a casemix and coding performance improvement plan

Course Outline