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Changes to Medicare Hospital Payment

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BforsbergCCP View Drop Down

Joined: Aug 24 2009
Location: United States
Online Status: Offline
Posts: 3
  Quote BforsbergCCP Quote  Post ReplyReply bullet Topic: Changes to Medicare Hospital Payment
    Posted: Mar 10 2010 at 3:46pm

Changes to Medicare Hospital Payment 2007-2008
Submitted by Peggy Dotson, RN, BS
Member, AAWC Government and Regulatory Affairs Task Force

CMS has introduced a new DRG system that is more specific. It's now known as the Medicare Severity-Diagnosis Related Groups or MS-DRGs. It became effective October of this year.

How MS-DRG Work:

Medicare has converted their Diagnosis Related Groups (DRGs) system to a more specific group set based on the severity of the diagnosis known as Medicare Severity-DRGs (MS-DRGs). This has allowed the Centers for Medicare and Medicaid Services (CMS) to introduce multiple MS-DRGs in place of an existing DRG that was assigned to a diagnosis group with complications. Now Medicare can split a single DGR w/ complications into 2 MS-DRGs; 1) for major complications (MCC) and 2) for regular complications (CC). Payment is then adjusted accordingly.


This change helps shift cost and allows Medicare to pay less for cases that are not major complicated cases. It will take away the payment buffer for many of the DRGs w/ complications resulting in a squeeze for hospital providers. CMS has released the new MS-DRG codes which have gone from 557 to 999.

This will heighten the need for a review of cases that are complex and the hospital procedures to provide the best care and eliminate complications that increase costs and length of stay (LOS).

What’s Next
This will be followed by another major change to the way Medicare pays hospitals in 2008. Medicare no longer will reimburse hospitals for the treatment of preventable errors, injuries and certain infections that occur in the facilities. Under the rule, Medicare no longer will reimburse hospitals for the treatment of certain conditions that could reasonably have been prevented, and the facilities cannot bill the beneficiary for any charges associated with the hospital-acquired complication

The eight conditions included in the proposed rule for which Medicare no longer will reimburse hospitals for treatment include:






mediastinitis, an infection that can develop after heart surgery



urinary tract infections that result from improper use of catheters



pressure ulcers (Stage III and IV)



vascular infections that result from improper use of catheters



three "never events":



objects left in the body during surgery



air embolisms



blood incompatibility

See any perfusion related issues?
Brian C. Forsberg BS,CP
MPH Candidate 2010
Brian C. Forsberg BS CCP-LP
<br />Director of Perfusion
<br />Gift of Life International
<br />
<br />
<br />The University of Oklahoma
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