Medicare Compliance & Reimbursement

More DRGs mean more money for hospitals.

Several diagnosis-related groups are on deck for updates, according to the Centers for Medicare & Medicaid Services. Here's a peek at how the money will be flowing in October 2004. CMS will:

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;

provide higher payments for spinal fusions requiring two incisions by removing single-incision procedures from that DRG; and

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