Medicare Severity-Diagnosis Groups
Medicare Severity-Diagnosis Groups
Diagnosis related groups (DRGs) have been around since the early 1980s, evolving over the years as a patient classification system. However, since October 1st, 2007, Medicare relies on the Medicare Severity-Diagnosis Group (MS-DRG) system to facilitate payments of services rendered for Medicare inpatients.
The Beginning of MS-DRGs
In the late 1960s, Yale University’s School of Management worked with Public Health to begin design and development of the DRG system. Initially, the goal of the DRG was to create an effective framework for monitoring the quality of care and application of services within a hospital setting. A variety of DRG systems have been developed in the past 25 plus years, each one evolving. …show more content…
DRGs are always changing and evolving. What may not have been needed to include in the report for determination one year may have changed for the next. Case in point, diabetes. In the past, DRGs only required knowing if a patient’s diabetes was insulin dependent. However, over time, things like knowing if it was type 1 or type 2 began to be needed. A diagnosis documented as acute, chronic, or not specific can have three different levels of payment. (Sturgeon, DRGs: Still Frustrating After All These Years, 2009)
Financial Impact
With MS-DRG implementation, hospitals experienced increases or decreases in payment. Medicare no longer has a fee-for-service reimbursement policy. Nowadays, Medicare pays for the care under IPPS. Each case is assigned a MS-DRG and that MS-DRG assignment determines how much the hospital will be reimbursed. This payment reflects the average length of time that group received care as an inpatient. If a patient is discharged before the average, the hospital will see a profit; however, on the opposite hand, if a patient stays longer than average, the hospital loses profit.
In conclusion, MS-DRGs are a great way to control Medicare costs, keep track of patients, and increase accurate medical documentation. However, with its constant evolution, professionals need to keep themselves up-to-date on all MS-DRG changes and new
Diagnosis related groups (DRGs) have been around since the early 1980s, evolving over the years as a patient classification system. However, since October 1st, 2007, Medicare relies on the Medicare Severity-Diagnosis Group (MS-DRG) system to facilitate payments of services rendered for Medicare inpatients.
The Beginning of MS-DRGs
In the late 1960s, Yale University’s School of Management worked with Public Health to begin design and development of the DRG system. Initially, the goal of the DRG was to create an effective framework for monitoring the quality of care and application of services within a hospital setting. A variety of DRG systems have been developed in the past 25 plus years, each one evolving. …show more content…
DRGs are always changing and evolving. What may not have been needed to include in the report for determination one year may have changed for the next. Case in point, diabetes. In the past, DRGs only required knowing if a patient’s diabetes was insulin dependent. However, over time, things like knowing if it was type 1 or type 2 began to be needed. A diagnosis documented as acute, chronic, or not specific can have three different levels of payment. (Sturgeon, DRGs: Still Frustrating After All These Years, 2009)
Financial Impact
With MS-DRG implementation, hospitals experienced increases or decreases in payment. Medicare no longer has a fee-for-service reimbursement policy. Nowadays, Medicare pays for the care under IPPS. Each case is assigned a MS-DRG and that MS-DRG assignment determines how much the hospital will be reimbursed. This payment reflects the average length of time that group received care as an inpatient. If a patient is discharged before the average, the hospital will see a profit; however, on the opposite hand, if a patient stays longer than average, the hospital loses profit.
In conclusion, MS-DRGs are a great way to control Medicare costs, keep track of patients, and increase accurate medical documentation. However, with its constant evolution, professionals need to keep themselves up-to-date on all MS-DRG changes and new