MS-DRG QUESTIONS & ANSWERS RATED 100% CORRECT

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.What is the average relative weight? - ️️1.00000. Thus, cases with an MS-DRG of 2.0000, require twice as many resources as the average Medicare case. What is the hospital's payment rate? - ️️it's based on a regional adjusted standardized amount that considers the type of hospital and a wage index DRG Relative Weight X Hospital Base Rate = Hospital Payment - ️️ For any patient in an MS-DRG, the hospital knows in advance the amount of reimbursement it will receive from Medicare. - ️️ What are some things that will bump up the payment? - ️️disproportionate share hospital, indirect medical education, outliet, sole community hospitals First character of ICD10 - ️️is always an alphabetic letter. All the letters of the alphabet are utilized except U which the WHO has reserved for new diseases of uncertain etiology and for bacterial agents resistant to antibiotics.