IP-DRG Coding-Important Points for Reimbursement

Comprehensive IP-DRG Training by Medesun-Dr Guptha
A per diem rate is a set amount per day for each day the patient is in the hospital, regardless of the actual services provided or the costs for those services- The discharge day is not counted as a day in the hospital.
A chargemaster is a master inventory list of everything that can be reported or performed in the hospital
The IPPS pays a flat rate based on average charges across all hospitals for a specific diagnosis. These are based on a number of reimbursement methodologies
Rehabilitation-CMGs-Case mIx groups
SNF-RUG-resurce utilization groups
Home Health-HHRG-Home health resource group
Hospice=Per dim
Partial hospitalization services are full day programs for psychiatric services. step down program”
Swing bed facilities can swing their beds from hospital to Skilled Nursing Facility (SNF) levels of care.
The IPPS originally excluded these kinds of hospitals:
• Rehabilitation
• Psychiatric
• Children's
• Cancer
• Long term care
• Rehabilitation and psychiatric hospital distinct part units
• Hospitals located outside the 50 states and Puerto Rico.
Long term care hospitals (LTCHs) are certified as acute care hospitals, but LTCHs focus on patients who, on average, stay more than 25 days.

Long term care hospitals (LTCHs) are certified as acute care hospitals, but LTCHs focus on patients who, on average, stay more than 25 days.
• Hospital PPS (IP) payment is calculated: DRG RW X Base Rate (hospital specific) = Hospital Payment ($) for that DRG

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