Diagnosis Related Group

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The Significance of Documentation to MS-DRG
The patient classification system is known as the diagnosis-related group (DRG), has been replaced with Medicare Severity – DRG as decided by the Centers for Medicare & Medicaid Services (CMS) for the system of reimbursement. As a result, hospitals will be pushed to create detailed documentation regarding the conditions of the patients to avail of the appropriate and correct reimbursement. Proper documentation will play a crucial role in this new system of reimbursement due to the various changes in the system. Due to the shift of DRG to MS-DRG, the severity of the patient’s condition is now more accurately categorized and defined. Severity levels were established, leading to the separation of significant comorbidities with complications from just comorbidities and complications. The new system of reimbursement has also taken steps in ensuring that preventable conditions acquired within the hospital will not be reimbursed by Medicare, increasing the list of quality measures that are publicly reported. Proper documentation is the key for hospitals in receiving the full payment. This documentation will consist of the record and track of all quality measures employed (Rich Daly et al., 2007).
Moreover, due to the renumbering of DRGs to MS-DRG, the hospital is challenged more to accurately document in detail as the severity of each illness is split further into detailed classifications. In addition to this, the list for comorbidity/complication (CC) was also revised. Many CCs have been removed, and the new list consists mostly of acute diseases, whether acute exacerbations or end-stage of a particular chronic disease. The revised list also involved cases that are monitored intensively or needing technically complicated and expensive protocols. This revision additionally requires more detailed documentation to back up the medical records of the patients. MCCs are on the top of the list for the severity of illness with...