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MS-DRGs Provide Yet Another EHR Incentive
November 1, 2007
Hospitals looking for another reason to implement an electronic health records system now have one: a new Medicare payment system that requires more detailed documentation of care.
The Medicare Severity Diagnosis-Related Groups, which went into effect Oct. 1, replace the original DRG system launched in 1983. To earn maximum reimbursement under the 745 new severity-adjusted MS-DRGs, hospitals must provide detailed evidence of such factors as complications and co-morbidities through appropriate coding, explains Carol Spencer, manager of professional practice resources at the American Health Information Management Association. The Chicago-based group represents coders, health information managers and others who work at provider organizations.
"The new MS-DRG system provides more challenges to generate the detailed codes that are going to fairly represent the patient in both the reimbursement arena and the quality arena," Spencer says. "That's a challenge because of, in many cases, the lack of specificity in the documentation."
Thus it's more important than ever for physicians to provide detailed documentation of care, ideally in an electronic records system, she contends. "Electronic records systems need to capture complete, very specific documentation that then will allow complete, accurate and consistent coding," she says.
Hospitals must take steps to ensure that all clinicians entering documentation in paper-based or electronic records systems "understand the level of detail necessary to get reimbursed and to provide quality data to Medicare," Spencer says. "There's a gap there that we need to bridge."
Medicare uses quality data to determine, in part, whether a hospital deserves somewhat higher reimbursement, she explains. The MS-DRGs will help provide this data, along with more specific reimbursement than the previous 538 DRGs in the old system, she adds.
Health information managers face the challenge of monitoring compliance with multiple reimbursement systems, including Medicare's inpatient MS-DRGs and outpatient APR-DRGs, Medicaid's payment system and those of private payers, Spencer says.
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