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Medicare Severity Diagnosis-Related Groups Bunnie Cobb, RHIT, CCS EOHIMA - September 22, 2007.

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Presentation on theme: "Medicare Severity Diagnosis-Related Groups Bunnie Cobb, RHIT, CCS EOHIMA - September 22, 2007."— Presentation transcript:

1 Medicare Severity Diagnosis-Related Groups Bunnie Cobb, RHIT, CCS EOHIMA - September 22, 2007

2 New DRG System Version 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

3 RAND Comparison

4 RAND Comparison continued

5 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)

6 Types of MS-DRGs

7 Examples of DRG Groups MS-DRGMS-DRG Title 009Bone marrow transplant 131Cranial/facial procedures w CC/MCC 132Cranial/facial procedures w/o CC/MCC 175Pulmonary embolism w MCC 176Pulmonary embolism w/o MCC 177Respiratory infections & inflammations w MCC 178Respiratory infections & inflammations w CC 179Respiratory infections & inflammations w/o CC/MCC

8 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%

9 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

10 Only a CC if Patient Discharged Alive , Ventricular fibrillation 427.5, Cardiac arrest , Cardiogenic shock , Other shock without mention of trauma 799.1, Respiratory arrest

11 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 OR ???

12 What to Expect Extreme scrutiny of Case Mix More physician queries + Delays in billing = More pressure on coders

13 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

14 References AHIMAs CoP for Inpatient ahima.org CMS website for IPPS CMS Adopts DRG Overhaul in IPPS Final Rule, 8/10/07 Journal of AHIMA: Severity-Adjusted DRGs for FY 2008? July 2007 Positioning Your Facility for Severity Adjusted Coding, April 2007


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