Medicare Severity Diagnosis Related Groups MSDRG Correction Notice

$79 / year

This dataset file includes the list of Medicare Severity Diagnosis-Related Groups (MS-DRGS) Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay Correction Notice.

Complexity

Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
The base payment rate is divided into a labor-related and nonlabor share. The labor-related share is adjusted by the wage index applicable to the area where the hospital is located, and if the hospital is located in Alaska or Hawaii, the nonlabor share is adjusted by a cost of living adjustment factor. This base payment rate is multiplied by the DRG relative weight.
If the hospital treats a high-percentage of low-income patients, it receives a percentage add-on payment applied to the DRG-adjusted base payment rate. This add-on, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payment for hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients. For qualifying hospitals, the amount of this adjustment may vary based on the outcome of the statutory calculation.
Also, if the hospital is an approved teaching hospital it receives a percentage add-on payment for each case paid through IPPS. This add-on known as the indirect medical education (IME) adjustment, varies depending on the ratio of residents-to-beds under the IPPS for operating costs, and according to the ratio of residents-to-average daily census under the IPPS for capital costs.
Finally, for particular cases that are unusually costly, known as outlier cases, the IPPS payment is increased. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added to the DRG-adjusted base payment rate, plus any DSH or IME adjustments.

Date Created

2016-07-27

Last Modified

2017-09-29

Version

2017-09-29

Update Frequency

Annual

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

DRG, DRG Codes, Diagnosis Related Groups, Diagnosis Group, Healthcare DRG, CMS DRG, DRG Definition

Other Titles

Medicare Severity Diagnosis Related Groups MSDRGS Correction Notice CN DRG, Medicare Severity Diagnosis Related Groups MSDRGS Correction Notice CN Healthcare DRG, Medicare Severity Diagnosis Related Groups MSDRGS Correction Notice CN DRG Definition

Name Description Type Constraints
MSDRGMedicare Severity Diagnosis Related Groups is a system of classifying a Medicare patient's hospital stay into various groups in order to facilitate payment of services.stringrequired : 1
Is_Final_Post_Acute_DRGTrue or False for DRGs under special rules created for patients who are discharged immediately following their hospitalization to a rehab hospital, skilled nursing facility, a long-term care hospital or home health care.boolean-
Is_Final_Special_Pay_DRGDRGs under special payment rule (True or False).boolean-
Major_Diagnostic_CategoryThe Major Diagnostic Categories (MDC) are formed by dividing all possible principal diagnoses from ICD-9-CM into 25 mutually exclusive diagnosis areas.string-
TypeSurgery or Medicine.string-
MSDRG_TitleDRG Diagnosis Related Group Description.string-
WeightsRelative Value Weights.numberlevel : Nominal
Geometric_Mean_LOSGeometric Mean Length of Stay.numberlevel : Ratio
Arithmetic_Mean_LOSArithmetic Mean Length of Stay.numberlevel : Ratio
MSDRGIs_Final_Post_Acute_DRGIs_Final_Special_Pay_DRGMajor_Diagnostic_CategoryTypeMSDRG_TitleWeightsGeometric_Mean_LOSArithmetic_Mean_LOS
864falsefalse18MEDFEVER0.87012.83.5
313falsefalse5MEDCHEST PAIN0.70241.82.2
885falsefalse19MEDPSYCHOSES1.17355.88.2
780falsefalse14MEDFALSE LABOR0.487921.62
509falsefalse8SURGARTHROSCOPY1.83213.94.9
637truefalse10MEDDIABETES W MCC1.33473.85
100truefalse1MEDSEIZURES W MCC1.64784.25.7
102falsefalse1MEDHEADACHES W MCC1.061134.1
593truefalse9MEDSKIN ULCERS W CC1.045944.9
638truefalse10MEDDIABETES W CC0.85122.93.6
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