Presented by: Bunnie Pasternak, CFCM, CPCM, Fellow INNOVATION140 CONSULTING, LLC
Medicare Severity Diagnosis-Related Groups Bunnie Cobb, RHIT, CCS EOHIMA - September 22, 2007.
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Transcript of Medicare Severity Diagnosis-Related Groups Bunnie Cobb, RHIT, CCS EOHIMA - September 22, 2007.
Medicare SeverityDiagnosis-Related Groups
Bunnie Cobb, RHIT, CCS
EOHIMA - September 22, 2007
New DRG SystemVersion 25
Biggest change to DRGs in 24 years RAND study winner More accurately groups severity of
illness (resource intensity) and payment Reduces incentives to specialty hospitals CMS committed to MS-DRGs
RAND Comparison
RAND Comparison continued
MS-DRGs
Uses CMS DRGs as foundation Consolidated current DRGs into base DRGs Made no changes to MDCs 14 and 15
(obstetrics and newborns) Eliminated:
Low volume DRGs Age-related DRGs
Increase in layers (subgroups)
Types of MS-DRGs
Examples of DRG Groups
MS-DRG MS-DRG Title
009 Bone marrow transplant
131 Cranial/facial procedures w CC/MCC
132 Cranial/facial procedures w/o CC/MCC
175 Pulmonary embolism w MCC
176 Pulmonary embolism w/o MCC
177 Respiratory infections & inflammations w MCC
178 Respiratory infections & inflammations w CC
179 Respiratory infections & inflammations w/o CC/MCC
Microsoft Excel Worksheet
CCs - The bad news
Removed >449 codes from the CC list Some of our most commonly coded conditions,
i.e. CHF, COPD, dehydration, atrial fibrillation Penalized for nonspecific diagnoses
CHF unspecified = not a CC Chronic diastolic or systolic CHF = CC Acute diastolic or systolic CHF = MCC
V24 cases had at least one CC 77.6% of the time, under V25 this will be reduced to 40.34%
Microsoft Excel Worksheet
CCs - The Good News ?
Previous reduction of codes on CCs list in 2006 from 3,326 to 2,583…
Now there are 4,922 codes that are either a Major CC or a CC: Major CC 1,580 codes CC 3,342 codes
Microsoft Excel Worksheet
Only a CC if Patient Discharged Alive
427.41, Ventricular fibrillation 427.5, Cardiac arrest 785.51, Cardiogenic shock 785.59, Other shock without mention of trauma 799.1, Respiratory arrest
Financial Impact $ $ $
CMS increased IPPS sum by 3.3% Reduction of RWs by 4.8% over 3
years to account for expected coding improvements
1.2% FY08 1.8% FY09 1.8% FY10
OROR ??????
What to Expect
Extreme scrutiny of Case Mix
More physician queries
+ Delays in billing
= More pressure on coders
How to Prepare
Learn the new rules Make the CC/MCC list your friend Review all query forms Plan when to query Educate yourself clinically Work with clinicians for more specific
documentation
References
AHIMA’s CoP for Inpatient Coding @ ahima.org
CMS website for IPPShttp://www.cms.hhs.gov/AcuteInpatientPPS/
CMS Adopts DRG Overhaul in IPPS Final Rule, 8/10/07http://health.cch.com/news/medicare/081007a.asp
Journal of AHIMA: Severity-Adjusted DRGs for FY 2008? July 2007Positioning Your Facility for Severity Adjusted Coding, April 2007