100% Review of the following focused DRG areas:

• 089 Simple pneumonia & pleurisy age 17 with CC
• 182 Gastroenteritis age 69 and/or CC
• 183 Gastroenteritis age 18-69 without CC
• 184 Gastroenteritis age 0-17
• 296 Nutritional & misc. metabolic disorders age 17 with CC
• 297 Nutritional and miscellaneous metabolic disorders, age > age 17 without CC
• 298 Nutritional and miscellaneous metabolic disorders, age 0-17
• 385 Neonates, died or transferred to another acute care facility
• 386 Extreme immaturity or respiratory distress syndrome, neonate
• 387 Prematurity with major problems
• 388 Prematurity w/o major problems
• 389 Full-term neonate with major problems
• 390 Neonate with other significant problems
• 468 Extensive OR procedure unrelated to principal diagnosis
• 475 Respiratory system diagnosis with ventilator support

100% Review of the following focused areas:

• Psychiatric and Substance Abuse with LOS < 5 days (codes 290-319)
• Review of Readmissions within 15 days (includes readmissions within 7 days)
• Day Outlier Review
• Inpatient Admission with LOS 3 days or < excluding DRG 391 (normal newborn), and DRGs 370-378, (C-section, and vaginal deliveries)
• Tonsillectomy and Adenoidectomy (Inpatient only - Effective 10/01/00)
• Higher Weighted DRGs
• Special Referrals - (as determined by the State)