What is an MS-DRG? - ️️An inpatient classification system designed to categorize
patients who are medically related with respect to diagnoses and treatment and who are
statistically similar in their lengths of stay. Each DRG has a preset reimbursement
amount.
All outpatient diagnostic servi...
MS-DRG
What is an MS-DRG? - ✔️✔️An inpatient classification system designed to categorize
patients who are medically related with respect to diagnoses and treatment and who are
statistically similar in their lengths of stay. Each DRG has a preset reimbursement
amount.
All outpatient diagnostic services and admission-related therapeutic services provided
by the same hospital on the day of the patient's admission or within three days
preceding the date of inpatient admission must be included on the inpatient hospital
claim to Medicare and is paid as part of the MS-DRG payment. No separate payment is
made for these outpatient services. - ✔️✔️
What are the three levels of severity? - ✔️✔️MS-DRG with MCC
MS-DRG with CC
MS-DRG
significant procedure - ✔️✔️- surgical in nature
- carries a procedural risk
- carries an anesthetic risk
- requires specialized training
principal diagnosis - ✔️✔️the condition established after study to be chiefly responsible
for admission to the hospital
complication - ✔️✔️an additional diagnosis that arises after the beginning of hospital
observation and modifies the course of the patient's illness or medical care required
comorbidity - ✔️✔️a preexisting condition that will likely cause an increase in the
patient's length of stay
principal procedure - ✔️✔️performed for definitive treatment (rather than diagnostic or
exploratory purposes), or when it is necessary to take care of a complication.
Acute care hospitals receive Medicare IPPS payments on a per discharge basis for
Medicare beneficiaries -- one payment per one inpatient hospital stay - ✔️✔️
What is relative weight? - ✔️✔️The average resources required to care for cases in the
particular DRG relative to the national average of resources required to treat all
Medicare cases.
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