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MS-DRG system makes complete documentation essential for maximum reimbursement and minimum denials

Case Management Weekly, March 11, 2008

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The idea behind CMS' Medicare Severity DRG (MS-DRG) system was to financially reward hospitals that treat patients with the most complex conditions. But facilities that do not understand the complexities of the MS-DRG system and are not documenting thoroughly could lose thousands of dollars once the system is fully implemented this October.

"We all know that one of the biggest struggles in the healthcare arena is capturing the severity of a case," said Sonya Stephens, a consultant with Sinaiko Healthcare Consulting, Inc., in Los Angeles during the January 17 HCPro, Inc., audioconference, "MS-DRGs in 2008: Assess the financial impact and operationalize the rule."

CMS continued the process of making severity more transparent when it implemented its Final Rule on August 1, 2007, which made the switch from the CMS-DRG classification system to the MS-DRG classification system. For case managers, the main points of interest of the MS-DRGs relate to major changes to the complication/comorbidity (CC) list and guidelines on diagnoses that are present on admission (POA).

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

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