GNYHA to Host Briefing and Training Sessions—Free to Members
On August 1, the Centers for Medicare & Medicaid Services (CMS) released its final Medicare inpatient rule. Among other things, as of October 1, 2007, CMS will begin replacing its current system of 538 diagnosis-related groups (DRGs) with 745 new DRGs known as Medicare Severity DRGs, or MS-DRGs.  

Along with the expanded list of DRGs comes a wholesale revision of the list of comorbidities and complications (CCs) that dictate which DRG applies to a particular patient's care and, consequently, whether the hospital is paid accurately for that care. Many DRGs have lower or higher levels of reimbursement depending on whether a patient has a CC. To ensure appropriate payment under the MS-DRG system, it is vitally important for hospitals to educate physicians, medical records coders, and others about the changes to the CC list. In addition, the new DRG system will require different and more precise coding than can be anticipated in advance, which will increase case-mix indices above anticipated levels and result in temporary overpayments. As a result, CMS made a prospective cut to DRG payments of 1.2% for the coming year to avoid those overpayments. This lends more urgency to the need to master the new DRG system and revised CC list.

Assistance for Members: GNYHA is sponsoring two sets of activities for its members, at no charge, to help them understand the practical implications of CMS's changes. First, GNYHA is sponsoring a briefing on the changes with a focus on implications for staff productivity and the accuracy of Medicare reimbursement. Coding is expected to take a significantly longer amount of time because it will be necessary to capture more detailed codes in order to identify CCs that add to the cost and reimbursement of patient care. In addition, coders will have to abstract the "present on admission" (POA) indicator, which will require them to read progress notes written by physicians in order to determine whether a condition was present on admission or acquired as a result of complications that arose during the course of treatment. The briefing will cover MS-DRGs, significant secondary diagnoses (complications/cormorbidities ), two-tiered system (major CCs, or MCCs) and regular CCs, and conditions present on admission. The briefing will be held three times and will be conducted by Precyse Solutions through "webinars"—computer-enabled sessions—as follows:

• Session 1: Wednesday, August 22, 1:00 p.m.
• Session 2: Thursday, August 23, 10:00 a.m.
• Session 3: September (date and time to be announced)

GNYHA recommends this briefing for members' finance, business office, and medical records staff. 

In addition to the policy briefing, GNYHA will sponsor coding training sessions on September 10 and 11 that will focus specifically on medical records coding changes. These sessions will consist of four half-day segments that will be repeated in order to permit the maximum number of coders to attend. 

For more information, contact Stewart Presser, and to register, contact Anita Wall, both at GNYHA.