Question

Patient X was admitted to Happy Hospital and had an admission with a LOS of eight days. The final MS-DRG assigned to the inpatient stay was MS-DRG 901, Wound debridement for injuries with MCC. MS-DRG 901 has a GMLOS of 9 days and the relative weight of 4.1536. If the fully adjusted base rate for Happy Hospital is $7,350.00, what is the expected reimbursement amount for the admission

Answer 1

Under the MS-DRG system, CMS classifies illnesses by severity level (i.e., a complication or comorbidity (CC), a major complication or comorbidity (MCC), or non-CC) based on secondary diagnoses and procedures as documented using ICD-10-CM codes. A relative weight (RW) is assigned to each MS-DRG that reflects the average cost to provide care for inpatients with a specific diagnosis relative to the average cost to provide care for all Medicare patients.

The GMLOS score, which is largely influenced by assigned diagnosis codes, is one of the components that Medicare considers when determining RWs reimbursement for MS-DRGs. Because hospitals do not typically receive additional reimbursement for hospital stays that exceed the expected length of stay, the goal is to discharge patients before they exceed this calculated average.

Here in the present scenario, For the Patient X the assigned inpatient MS-DRG is 901 and has a GMLOS of 9 days and the relative weight is 4.1536

Then we can that,

The hospital would receive 315% more than the average payment