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The history, design, and classification rules of the DRG system, as well as its application to patient discharge data and updating procedures, are presented in the CMS DRG Definitions Manual (Also known as the Medicare DRG Definitions Manual and the Grouper Manual). A new version generally appears every October. The 20.0 version appeared in 2002.
In 1994 about 5000 hospitals were eligible to receive CMS funding as a result of being reviewed by the Joint Commission. [9]The Medicare Improvements for Patients and Providers Act of 2008 removed the deemed status of the Joint Commission and directed it to re-apply to CMS to seek continued authority to review hospitals for CfC and CoP.
In 2007, the Centers for Medicare and Medicaid Services (CMS) put forth a report to Congress called "Promoting Greater Efficiency in Medicare. [8]" In its section on readmissions, CMS made the case for closer tracking of hospital readmissions and tying reimbursement to lowering them, citing a 17.6% 30-day readmission rate for Medicare enrollees ...
This provides a basis for describing the types of patients a hospital or other health care provider treats (its case mix). Case mix groups are used as the basis for the Health Insurance Prospective Payment System (HIPPS) rate codes used by Medicare in its prospective payment systems. [1]
Factors Influencing Health Status and Other Contacts with Health Services 939 - 951 24 Multiple Significant Trauma 955 - 965 25 Human Immunodeficiency Virus Infection 969 - 977 MDC Category Missing 981 - 989; 998,999
Case Managers concurrently plan for transitions of care, discharge and often post discharge follow up. Case Managers often coordinate with the patient and family, physician(s), funding sources (i.e. insurance, Medicare), and community resources that provide services the patient may need, such as rehabilitation facilities or providers of medical ...
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The MDS is updated by the Centers for Medicare and Medicaid Services. Specific coding regulations in completing the MDS can be found in the Resident Assessment Instrument User's Guide. Versions of the Minimum Data Set has been used or is being utilized in other countries.