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Requirements
MEDICAL BILLING AND CODING
APPLICATION PAPER
Solution
Application paper on MS-DRGs
The MS – DRG (Medicare severity diagnosis affiliated group) is a system in order to classify a Medicare hospital stay of patients to groups to grease up the service payments that further enables payment to align closely with the maximum utilization of resources. The diagnosis affiliated to groups is defined as the inpatient division that further classifies the patients which are similar in terms of treatment, resources, duration of stay, age and diagnosis. Under the system of prospective payment, the hospitals are being paid in order to treat the patients in a category of DRG. Further, it is a system which is used as a tool to utilize the procedure of review, measurement of the risk and the reimbursement (Centers for Medicare & Medicaid Services. 2013). MS – DRG is used to demonstrate the various kind of patient care like pediatric, management of data, comparability, newborn, benchmarking and reimbursement. Moreover, the DRG is entrusted along with the episode’s numeric value of care with the weight that is betrothed to demonstrate the intensity of resources of the clinical group. The payment level of the group is being determined, and further, the guidelines are given which are utilized for the formulation of the system of DRG. Firstly, the attributes of the patients which are used in the definition of DRG and should be restricted to the information which is collected on the billing form of the hospital. Secondly, the number of DRGs should be manageable which encompasses the patients on the basis of inpatient. Thirdly, every DRG must include the patients with an analogous pattern on the basis of the intensity of resources. Lastly, every DRG must include patients who will be comparable from the clinical perception (Rosenbaum et al., 2014).
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Furthermore, the architecture of the system of DRG is hierarchical, and the greatest level is known as the major diagnostic category. It demonstrates the system body which is being treated by the medicine and includes 23 MDCs along with the DRG group that is related to all the MDCs. The MDCs were being added to show the infection of human immunodeficiency virus and the categories of multiple trauma. Further, the level is divided into surgical and medical sections. The DRGs components are the arithmetic mean duration of stay, the geometric mean duration of stay, title, weight, the procedure of operating room, etc. the administrative contractors of Medicare uses groupers in order to calculate the MS-DRG payment for the encounter od each hospital. Moreover, grouper is defined as a program that utilizes an algorithm to assign each patient to the group, classes or category (Morley et al., 2014).
The system of DRG is used for the system of payment and reimbursement as a payment method which will be prospective for the inpatient services of the hospital that are being provided to the beneficiaries of the Medicare. Therefore, it is accustomed to a based model of prospective in which the hospitals will get the payment depending on the diagnosis of the patients. The factors which are being used for the calculation of DRG are the intensity of the resources, intervention need, mortality risk, etc.
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Centers for Medicare & Medicaid Services. (2013). Acute Inpatient PPS: list of final MS-DRGs, relative weighting factors and geometric and arithmetic mean length of stay.
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Morley, M., Bogasky, S., Gage, B., Flood, S., & Ingber, M. J. (2014). Medicare post-acute care episodes and payment bundling. Medicare & Medicaid research review, 4(1).
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Rosenbaum, B. P., Lorenz, R. R., Luther, R. B., Knowles-Ward, L., Kelly, D. L., & Weil, R. J. (2014). Improving and measuring inpatient documentation of medical care within the MS-DRG system: Education, monitoring, and normalized case mix index. Perspectives in Health Information Management, 11(Summer).
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