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In This Issue:
On Oct. 1, the Centers for Medicare & Medicaid Services changed from the Diagnostic Related Group (DRG) coding system, to a new system called Medicare Severity – Diagnostic Related Groups, or MS DRGs, as part of its acute hospital reimbursement methodology. In this new system, specificity of documentation is key to allow accurate capture of patient severity of illness appropriate hospital payment.
CMS will also continue its three-year transition to cost-based relative weights, with two-thirds of the FY 2008 weight based on costs and one-third based on charges. This change includes a payment cut to eliminate what CMS says will be the effect of coding or classification changes that do not reflect real changes in case-mix.
“Severity will become the basis for reimbursement and coding, and therefore knowledge of new requirements and new rules will be critical to maintaining revenue,” said Michael Gustafson, MD, MBA, vice president for Clinical Excellence. “This makes physician collaboration with our current DRG assurance nurses -- who do concurrent chart reviews and query physicians for more specific diagnoses and documentation when needed – more important than ever.”
The new system creates 745 new MS-DRGs to replace its previous system of 538 DRGs, and will revise the complication or co-morbidity list. All DRGs have different numbers in the new system, and the new registry for DRGs contains gaps that will allow for CMS to insert additional DRGs in the future. The reclassification will create up to three tiers of payment for each diagnosis, based on the presence of a major complication or co-morbidity (MCC), a minor complication or co-morbidity (CC) or no complication or co-morbidity (non-CC).
Specific documentation in histories and physicals, progress notes and discharge summaries is necessary for accurate coding.
For questions related to these changes, please contact Gustafson at mgustafson@partners.org, or Bernice von Saleski, RHIA, MAS, PHS Corporate Coding Manager II, at bvonsaleski@partners.org