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MS DRG changes for 2019

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Each year, CMS makes changes to DRGs under the IPPS rule that affect how hospitals are reimbursed. Because IPPS hospitals are paid based on Medicare Severity Diagnosis Related Groups (MS-DRG), additions, deletions, or alterations to MS DRGs can affect how hospitals should submit claims to Medicare.

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MS DRG changes for 2019

  1. 1. MS DRG Changes – 2018 recap and 2019 look ahead
  2. 2. Because IPPS hospitals are paid based on Medicare Severity Diagnosis Related Groups (MS-DRG), additions, deletions, or alterations to MS DRGs can affect how hospitals should submit claims to Medicare.
  3. 3. 2018 MS DRG and ICD 10 Changes
  4. 4. MS DRG changes in the 2018 final rule • A reduction in the number of MS DRGs from 757 to 754. • DRGs 984, 985 and 986 deleted. • There were several DRG name changes to clarify the actual MS DRG diagnosis codes. • There were no new DRGs added to the list of MS-DRGs subject to the post-acute care transfer policy (PACT). Additionally, there were no MS-DRGs eliminated from the list. The list remains at 280 DRGS impacted by the rule. • The special payment policy had DRGs 987, 988 and 989 added and now has 40 MS DRGs on the list that qualify for special payments.
  5. 5. ICD 10 changes in the 2018 final rule • 324 new ICD-10-CM diagnosis codes proposed for fiscal 2018 • 3,151 new ICD-10-PCS procedure codes • 38 invalid ICD-10-CM diagnosis codes • 641 invalid ICD-10-PCS procedure codes • 43 revised ICD-10-CM diagnosis code titles • 1,808 revised ICD-10-PCS procedure code titles
  6. 6. 2019 proposed changes
  7. 7. The 2019 proposed IPPS final rule issued in April 2018 suggests… • MS DRGs increased from 754 to 759 • DRGs 685,765, 766, 767, 774, 775, 777, 778, 780, 781, 782 are deleted • DRGs 783, 784, 785, 786, 787, 788, 797, 798, 799, 805, 806, 807, 817, 818, 819, 831, 832 and 833 are added. • 435 ICD 10 code changes • 247 new codes • 139 revised codes • 49 deleted codes
  8. 8. The increase of the MS-DRGs are for vaginal delivery, Cesarean Section procedures and antepartum care and procedures.
  9. 9. Most of the newly proposed ICD-10-CM codes are found in Neoplasms Diseases of the eye and adnexa and injury, poisoning and certain other consequences of external causes.
  10. 10. There are proposals to revise the MS-DRG classifications based on the additional ICD- 10 codes previously referenced, but do not impact the number of overall DRGs or the ones impacted by the transfer policy. For 2019, there are no additional DRGs that will be impacted by the transfer policy.
  11. 11. Proposed MS DRG changes affecting hospice reimbursement
  12. 12. In 2018, providers are entitled to the full MS DRG when 50 or 51 is used. Should the provisions in the 2019 proposed rule survive, providers will receive a per diem payment instead. As established in the Bipartisan Budget Act of 2018, discharges to hospice services provided by a hospice program will be impacted by the post-acute care transfer policy.
  13. 13. MS DRG changes can affect how Transfer DRG underpayments and overpayments are properly recovered. Without displacing or disrupting a current review vendor or internal process, BESLER can provide a secondary validation of impacted transfer claims to ensure you are identifying all potential underpayments and overpayments. *HFMA staff and volunteers determined that Transfer DRG Revenue Recovery Service has met certain criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this service. Learn how to recover more Transfer DRG underpayments besler.com/transfer-drg-revenue-recovery

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