MS-DRG System Analysis

This system was first developed in the 1970’s by Yale University and is continually evolving. The MS-DRG system involves seven hundred and thirty-five Medicare-severity diagnoses related groups. This system was created to help regulate the cost associated with inpatient care for Medicare beneficiaries and establish uniformity in charges provided by healthcare facilities. The MS-DRG system is continually being re visited and changed due to the continued evolvement of healthcare. These groups are used for inpatient payments involving Medicare reimbursement. This system does involve a four-step process in determining proper payments to the healthcare facility. The steps involved in the MS-DRG system for payment purposes include the following predetermination if the patient encounter is qualified for the MS-DRG system. After making this predetermination the next step is to determine from the primary diagnoses and assigning one of the MDC categories. The third step would be to determine the medical and or surgical procedure if performed if it qualifies in to one of the …show more content…
Encounters forms must be completed along with accurate medical documents related to health care procedures preformed by providers at the healthcare facility. Documentation needs to be accurate beginning with patient demographics, progress notes, patient history and physical, allergies, current medications and relevant procedures performed. The combination of all the medical data on the patient translates in to how medical coders and billers apply the use of the MS-DRG system. When documentation provided by healthcare professionals is accurate this translates to better reimbursements rates and a smaller margin for error along with faster payouts to facilities. When documentation or medical coding and billing errors are made this prolongs the process of payment to the healthcare