Severity-Adjusted Diagnosis-Related Group Case Study
Medicare Severity Diagnosis-Related Groups
“For fiscal year 2008, Medicare adopted a severity-adjusted diagnosis-related group system called Medicare Severity Diagnosis-Related Groups or MS-DRGs. This was the most drastic revision to the DRG system in 24 years.” (Schraffenberger, 2016, p. 702)
MS-DRGs had a single goal to which was to improve the ability to recognize the severity of a patient’s illness for inpatient hospitals. Within this system hospitals with the sickest patients would receive higher payments, and those with patients with less sever illness would receive decreased payments.
There are currently three levels of severity that are used in the MS-DRGs. The first is MCC
MS-DRGs with major complications or …show more content…
Is a major or complex diagnosis present? And what is the patients discharge status?
Impact of Financial and Documentation on MS-DRGs
Accurate and valid procedure and diagnosis coding is vital when assigning MS-DRGS. One of two error MS-DRGs may be assigned when invalid documentation is given on a patient’s claim form. MS-DRG 998 or Principal Diagnosis Invalid as Discharge Diagnosis is assigned when the principal diagnosis is not specific.
MS-DRG 999 or Ungrouping is assigned when an invalid diagnosis code such as age or sex is reported. The payment amount for both the MS-DRG 998 and MS-DRG 999 would then be $0 and the claim will be sent back to the provider for correction and then resubmitted to Medicare.
The financial impact of the MS-DRGs for Medicare inpatients services is that the hospital can experience both profit and loss for each individual case. Reimbursements are based on each individual case and the hospital will receive a fixed amount regardless of the treatment received.
MS-DRGs also uses provisions to provide specialized programs additional payments, Without those additional payments it may not financially smart for an acute care hospital to provide services to Medicare
“For fiscal year 2008, Medicare adopted a severity-adjusted diagnosis-related group system called Medicare Severity Diagnosis-Related Groups or MS-DRGs. This was the most drastic revision to the DRG system in 24 years.” (Schraffenberger, 2016, p. 702)
MS-DRGs had a single goal to which was to improve the ability to recognize the severity of a patient’s illness for inpatient hospitals. Within this system hospitals with the sickest patients would receive higher payments, and those with patients with less sever illness would receive decreased payments.
There are currently three levels of severity that are used in the MS-DRGs. The first is MCC
MS-DRGs with major complications or …show more content…
Is a major or complex diagnosis present? And what is the patients discharge status?
Impact of Financial and Documentation on MS-DRGs
Accurate and valid procedure and diagnosis coding is vital when assigning MS-DRGS. One of two error MS-DRGs may be assigned when invalid documentation is given on a patient’s claim form. MS-DRG 998 or Principal Diagnosis Invalid as Discharge Diagnosis is assigned when the principal diagnosis is not specific.
MS-DRG 999 or Ungrouping is assigned when an invalid diagnosis code such as age or sex is reported. The payment amount for both the MS-DRG 998 and MS-DRG 999 would then be $0 and the claim will be sent back to the provider for correction and then resubmitted to Medicare.
The financial impact of the MS-DRGs for Medicare inpatients services is that the hospital can experience both profit and loss for each individual case. Reimbursements are based on each individual case and the hospital will receive a fixed amount regardless of the treatment received.
MS-DRGs also uses provisions to provide specialized programs additional payments, Without those additional payments it may not financially smart for an acute care hospital to provide services to Medicare