Is this applicable only to physician private practices or physicians working for an hospital still get paid through this scheme instead of a periodic salary paid by the hospital?
I believe that in the situations where we have DRG based reimbursement, the procedures have to be reported in ICD (ICD-9-CM Vol.3 or ICD-10-PCS) instead of CPT/HCPCS. Is this true?
May I assume that DRG based payment is an alternative to RBRVS based payment
DRGs are used mainly for reimbursement in Inpatient settings while RBRVS is the main reimbursement basis when not using DRGs?
Ugh, I just had a long reply and lost it, so it's shorter than the original, lol.
Medicare uses the MS-DRGs (medical severity diagnosis related groups) and they have very large PDFs that list the CC/MCC ...
Thanks for the response.QuoteUgh, I just had a long reply and lost it, so it's shorter than the original, lol.QuoteI've done that myself, so I know the feeling.No problem and it sure does. QuoteMedicare uses the MS-DRGs (medical severity diagnosis related groups) and they have very large PDFs that list the CC/MCC ...I linked to this in my response above. Is this the type of list you are talking about?http://www.smainformatics.com/pdfs/IPPS_FY2012MSDRG.pdf
I've done that myself, so I know the feeling.
Based on the words quoted above, it appears that DRGs are assigned after-the-fact (someone please correct me if I am wrong). That is, the DRG selected to describe the current case is based on the diagnosis code (ICD-9) and the procedure code (CPT/HCPCS) used for that encounter.
Finally, note that we are using two different and distinct code sets. rferreira, the words you used make me think you maybe don't realize this. Diagnosis Codes (ICD-9 or 10) are different from procedure codes (CPT) As described above, both sets of codes must be used to ensure proper payment, whether you are using the RBRVS method or the DRG method.
The RBRVS - used by Medicare/other govt programs for Physician and outpatient services
Now, based in your contribution and what I have investigated I reached the conclusion that DRGs are used mainly in inpatient where procedures are coded (almost) only in ICD ...
... I often see refering to "Physician and outpatient services".
Dalia,Thank you very much for your valuable insights.
In what concerns the CC/MCC, isn't it somehow overlapped by the POA indicator? If a diagnosis is marked as a complication (=acquired inside the hospital) doesn't it necessarily mean that its POA=false?