What is the difference between ap drg and ms drg

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Powered by UnitedThemes. Username Password Remember Me Lost your password? The relative weight reflects the average hospital resource use for a patient in that 3M APR DRG relative to the average hospital resource use of all inpatients. Please note that payers and other users of the 3M APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations.

Link to information about the code system - including how to obtain the content from 3M - is available here. In , the state of New York passed legislation instituting a DRG-based prospective payment system for all non-Medicare patients.

Goldfield N. The evolution of diagnosis-related groups DRGs : from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manage Health Care. The MS-DRG considers the reason for admission, the most costly secondary diagnosis based on a national average, and any particularly costly procedures—usually one related to the reason for admission.

MS-DRGs frequently are described as a way to demonstrate how sick patients are, but in reality, they reflect how costly they tend to be, on average, in a large population. An individual patient can be quite sick and die—quickly—and not be expensive to treat in the hospital. Another patient may have a chronic illness that needs IV medication or inpatient monitoring and stay longer than usual in the hospital but not be particularly expensive to treat compared with another who needs extensive medical and surgical intervention.

Each base APR-DRG, however, considers severity of illness and risk of mortality instead of being based on a single complication or comorbidity. Because of the four levels of severity of illness or risk of mortality minor, moderate, major, severe , the APR-DRG not only facilitates reimbursement but also enables internal and public reporting on these two factors.

There are likely to be numerous pregnant patients, newborns, and children as well as the occasional trauma patient. However, this type of age group and medical mix usually does not include a high percentage of severely ill patients. If the Medicaid population is low, chief financial officers will want to make sure that coding is accurate and billing processes are adapted to the new methodology.