The work on a review case begins months after the patient has gone home.
Coding happens at the end of the case, under time pressure, from whatever the record offers. When the review notice arrives later, the same record has to be opened again, the coding reconstructed and the justification written from scratch. By then, the colleague handling it may well not be the one who coded the case.
1review noticeThe Medical Service (MD) announces a review of a case billed long ago.
4monthsThat is the gap between discharge and notice; by then, the case is forgotten.
1contested secondary diagnosisThe DRG depends on it, and with it the revenue for the whole case.
2rounds of workOnce to reconstruct the coding, once to justify the objection.
If the passage in the record that supports the secondary diagnosis is identified at first coding, half of this work disappears: that is the 50% less review effort.
The 50% is this agent's headline figure. The four-month gap and two rounds of work per review case reflect a typical case in medical controlling; they are not measurements.