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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.
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
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
(6005F–6150F) Patient safety (7010F–7025F) Structural measures (9001F–9007F) Non-measure claims-based reporting; CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. Because CPT II codes are not associated with any relative value, they are billed with a $0.00 billable charge amount. [10]
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 ...
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 ...
APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the ...