Be adaptable and ready for change if you are responsible for payer reimbursements in your healthcare organization. The Centers for Medicare & Medicaid Services (CMS) has announced a large number of changes to diagnosis-related groups DRGs for 2018, along with changes in ICD-10-CM and PCS. Here is a quick summary of the changes:
Hospitals and other providers have been expecting CMS to adjust MS-DRGs based on its data analysis of a full year of ICD-10 information. The proposed changes will affect discharges occurring on or after Oct. 1, 2017, which is the start of the 2018 federal fiscal year.
Your organization’s preparation for changed DRGs should start with the basics:
To analyze the effect of the changes, use our Top 5 list to begin, and to develop actions you can take today to avoid denials and prepare:
You want to help your entire team understand changes that affect reimbursement. Remember to include the clinical documentation integrity (CDI) and utilization management (UM) teams in the education.
To ensure that your coding team is linking documentation to optimum coding, educate the team on ICD-10-CM and PCS, and DRGs. Provide the training and measure team skills before and after education refreshment. Staff education is frequently targeted during budget cuts, but recognize the important relationship between coding skills and your organization’s reimbursement.
The relationship between case mix index (CMI) and DRGs is important to monitor in order to understand impacts to CMI. Monitor your DRGs and ensure that your clinical documentation integrity (CDI)and coding teams understand how important accurate coding is to the financial health of your organization.
Reimbursement and health information management (HIM) managers must be change-hardy to succeed. In today’s changing healthcare environment, where the one constant is rapid change, remain alert to trends in CMI and DRGs, since it has an affect your reimbursement.
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full
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