Medicare Inpatient Prospective Payment System

Decent Essays
Introduction
Medicare pays for the inpatient acute-care services. These payments are based on rate per discharge and by using the Medicare Severity Diagnosis Related Group (MS-DRG) which are assigned to the patients.
The MS-DRG is the system by which the Medicare patient’s hospital stay has been classified into different groups in order to make the payments for the services. The MS-DRG assigns code such as 190 stands for chronic obstructive pulmonary disease with MCC. The codes are distributed on the basis of major complication or comorbidity [MCC] and without MCC.
There have been studies which have suggested that the cost of certain procedures for the MS-DRG are going to increase exponentially as the demand for such procedures will rise.[1] With a view to bring a control on the rising costs of care, the Center of Medicare & Medicaid
…show more content…
hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments from billed discharges, Payments that are paid under Medicare based on rate per discharge using Medicare Severity Diagnosis Related Group (MS-DRG) for three consecutive years 2012,2013 and 2014.
We are analyzing the top 3 Diagnosis-related group (DRG) conditions based on sum of total discharges with MCC and without MCC (major complications and comorbidities). Thus, a total of 6 Diagnosis-related group (DRG) conditions.
Data:
Data Source: The data set that we are analyzing is from CMS.gov- Medicare Provider Utilization and Payment Data: Inpatient. CMS provides the data related to Inpatient Charge Data for the FY 2011 to 2014.
Study Population: Medicare IPPS providers within 50 United States and District of Columbia who are billing Medicare fee-for service.
Year: We are analyzing latest data available which is 2014 data.
The variables that are included in the study are:
1. DRG:
2. Total Discharges
3. Average Covered

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