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Case managers play a critical role in clinical documentation improvement in light of new MS-DRGs

Case Management Weekly, February 19, 2008

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In October 2007, CMS implemented the most dramatic restructuring of the DRG system since its inception in 1983. The new system is called Medicare Severity DRGs (MS-DRG) and is meant to better align reimbursement with the severity of patients' conditions and costs associated with care.

Under the MS-DRG system, the old 538 DRGs have been reduced to 335 base MS-DRGs; however, these 335 base DRGs are further split into two or three subgroups, resulting in a total of 745 MS-DRGs. CMS also introduced major complications and comorbidities (MCC) and revised the overall complication and comorbidity (CC) list after several years of stasis. The three-level severity classification of some DRGs intends to appropriately allocate more of the resources and reimbursement to the sicker patients with cormorbid and medically complex conditions.

Source: To read more about this story, take a look at the February 2008 issue of Case Management Monthly.

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