Medical Billing and Coding
MEDICAL BILLING AND CODING
Application paper on MS-DRGs
Furthermore, the architecture of the system of DRG is hierarchical, and the greatest level is known as the major diagnostic category. It demonstrates the system body which is being treated by the medicine and includes 23 MDCs along with the DRG group that is related to all the MDCs. The MDCs were being added to show the infection of human immunodeficiency virus and the categories of multiple trauma. Further, the level is divided into surgical and medical sections. The DRGs components are the arithmetic mean duration of stay, the geometric mean duration of stay, title, weight, the procedure of operating room, etc. the administrative contractors of Medicare uses groupers in order to calculate the MS-DRG payment for the encounter od each hospital. Moreover, grouper is defined as a program that utilizes an algorithm to assign each patient to the group, classes or category (Morley et al., 2014).
The system of DRG is used for the system of payment and reimbursement as a payment method which will be prospective for the inpatient services of the hospital that are being provided to the beneficiaries of the Medicare. Therefore, it is accustomed to a based model of prospective in which the hospitals will get the payment depending on the diagnosis of the patients. The factors which are being used for the calculation of DRG are the intensity of the resources, intervention need, mortality risk, etc.
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Morley, M., Bogasky, S., Gage, B., Flood, S., & Ingber, M. J. (2014). Medicare post-acute care episodes and payment bundling. Medicare & Medicaid research review, 4(1).
Rosenbaum, B. P., Lorenz, R. R., Luther, R. B., Knowles-Ward, L., Kelly, D. L., & Weil, R. J. (2014). Improving and measuring inpatient documentation of medical care within the MS-DRG system: Education, monitoring, and normalized case mix index. Perspectives in Health Information Management, 11(Summer).