Get ready for MS-DRGs: Plan for dual DRGs

Many payers contract or reimburse based on Medicare’s DRGs. These include Medicare itself, for long-term care and psychiatric admissions, the Department of Defense, many state Medicaid programs, numerous Blue Cross/Blue Shield organizations, and other commercial payers. These payers have not yet indicated that they will be adapting CMS's MS-DRGs.

As a result, most provider organizations will need the ability to code using MS-DRGs for their Medicare billing, and use another set (and possibly even multiple sets) of severity-adjusted DRGs for their contracts with non-Medicare payers. The DRGs used by non-Medicare payers are likely to differ from MS-DRGs, such as including DRGs for pediatric encounters and other scenarios that are not covered under MS-DRGs.

To prepare for this, provider organizations should:

• Survey their DRG contracts.
• Track their payers’ movements toward severity adjustment.
• Make sure that their health information management, patient financial services and other departments are equipped to manage two or more sets of DRGs.

Ingenix MS-DRG Consulting Services
To address the dramatic impact that the proposed MS-DRGs will have on coding and billing for inpatient services, Ingenix has incorporate the new MS-DRG requirements into its proven programs, which include:

• Coding Quality and Compliance Program
• Clinical Documentation Improvement Program
• Customized MS-DRG Education