A classification system used by Medicare to group patients with similar clinical conditions and treatment into payment categories based on their diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities.
A system of classifying patient episodes of care based on similar clinical characteristics and resource requirements.
A measure within the MS-DRG system indicating the level of illness or severity of a patient’s condition, ranging from minor to extreme.
A component of the MS-DRG system that assesses the likelihood of a patient’s death due to the severity of their illness or condition.
The initial classification of a patient into a specific DRG category based on their principal diagnosis and procedures performed during the hospital stay.
Software used to assign Medicare Severity Diagnosis Related Groups (MS-DRGs) to inpatient cases based on clinical data.
A numerical value assigned to each MS-DRG representing the relative resource intensity or cost of treating patients within that group compared to other MS-DRGs.
The reimbursement amount assigned to each MS-DRG, calculated by multiplying the relative weight by a standard payment rate set by Medicare.
Ensuring accurate and complete documentation of patient diagnoses, procedures, and complications to support appropriate assignment of MS-DRGs and reimbursement.
Complications or conditions that develop during a hospital stay which were not present at admission, impacting MS-DRG assignment and reimbursement.