Essay on Physician Reimbursement Case

1910 Words Feb 20th, 2013 8 Pages
Physician Reimbursement Case

Discuss the general differences between facility and non-facility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? (Hint: your book is incorrect.)

Facility vs. Non-Facility Rates
The place of service can greatly affect reimbursement, depending on the type of service provided and the location. The reason being is that Medicare typically reimburses physicians based on a method called Relative Value Units (RVUs), which has three components: work,
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The MS-DRGs range from 001-999, with many unused numbers to accommodate future MS-DRG expansion. Every CMS DRG has been completely renumbered. Also, there is no correlation between the CMS-DRG numbers and the MS-DRG numbers. For example: CMS DRG 006 is Carpal Tunnel Release, while MS-DRG 006 is Liver Transplant w/o MCC.
As with CMS DRGs, one MS-DRG is assigned to each inpatient stay. The CMS-DRGs were assigned using the principal diagnosis and additional diagnoses, the principal procedure and additional procedures, age, sex and discharge status. On the other hand, the MS-DRGs use the same information, but they do not take into account the factor of age. Moreover, diagnoses and procedures assigned by using ICD-9-CM codes still determine the MS-DRG assignment. Accurate and complete ICD-9-CM coding by HIM professionals is even more essential for correct MS-DRG assignment and subsequent reimbursement.
The Major Diagnostic Categories (MDCs) have not changed with the implementation of MS-DRGs. With some exceptions, all principal diagnoses continue to be divided into one of 25 MDCs that generally correspond to a single organ system. Examples of MDCs include: * MDC 1 Diseases and Disorders of the Nervous System * MDC 2 Diseases and Disorders of the Eye * MDC 3 Diseases and Disorders of the Ear, Nose, Mouth and Throat * MDC 4 Diseases and Disorders of the Respiratory System * MDC 5 Diseases and Disorders of the Circulatory

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