The MS-DRG Grouper tool is built on Inpatient Prospective Payment System (IPPS) rules for inpatient Facility coding/reimbursement. The Grouper allows users to enter one or more ICD-10-CM diagnosis codes and any applicable ICD-10-PCS procedure codes along with some other required inputs, click a button, and quickly get the resulting DRG and other important information (including the Relative Weight, Length of Stay, Procedure Type, Post Acute indication, etc.).
The tool also includes an integrated DRG Payment Calculator - the default payment will be the National Unadjusted rate, but users can enter the Name or Hospital Provider Number/CCN to see the payment calculation calibrated for any hospital in the USA. The Payment Calculator clearly shows the different payment components (Federal Operating Payment, Operating Indirect Medical Education Add-on, Operating Disproportionate Share Hospital Add-on, other add-ons and adjustments etc.) as well as the Billed Outlier Threshold (if costs were unusually high - which can qualify for an additional outlier payment). All payment dollar amounts are based on Medicare reimbursement only.
* Available with Complete Coder
CPT is a registered trademark of the American Medical Association.