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Medicare Compliance & Reimbursement

Hospitals:

More DRGs Are Tapped For Pay Increase

Published on Sun Aug 22, 2004

How CMS plans to tinker with the inpatient prospective payment system.
 
Several diagnosis related groups are on deck for updates, according to the Centers for Medicare & Medicaid Services. Want to know how the money will be flowing in October 2004? Here's a peek.
     
CMS will:

     

  • carve out a new DRG for certain craniotomy procedures that involve the implantation of a chemotherapeutic agent, including acute complex central nervous system diagnoses;

         

  • increase payment for burn patients who have respiratory failure and require the long-term use of mechanical ventilation;
         
  • increase payment for heart assist devices (including left ventricular assist devices) by reassigning them to the DRG for heart transplants;

         

  • split the DRG for tracheostomy into two new groups, to allow for a higher payment when an additional surgical procedure is performed with a tracheostomy; and

         

  • provide higher payments for spinal fusions requiring two incisions by removing single incision procedures from that DRG.

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