Ballentine Noel H
Division of General Internal Medicine, Milton S. Hershey Medical Center, Penn State University, Hershey, Pennsylvania 17033, USA.
J Hosp Med. 2009 Feb;4(2):124-30. doi: 10.1002/jhm.416.
Effective October 1, 2007, the Centers for Medicare and Medicaid Services has changed its methodology for determining the diagnosis-related group for hospitalized patients. In an effort to more accurately reflect severity of illness, the 538 diagnosis-related groups have been converted to 745 new Medicare severity diagnosis-related groups. In addition, selected hospital-acquired complications not identified as present on admission will no longer be reimbursed. The changes will have profound effects on reimbursement for hospitalizations. To minimize financial losses under the new rules, hospitals and physicians will have to devote significant resources and attention to improved documentation. This article will discuss the new payment system, the physician's role in ensuring that all clinically important diagnoses are captured by coding specialists, and strategies that can be employed to respond proactively to the challenge.
自2007年10月1日起，医疗保险和医疗补助服务中心已更改其确定住院患者诊断相关组的方法。为了更准确地反映疾病的严重程度，538个诊断相关组已转换为745个新的医疗保险严重程度诊断相关组。此外，选定的入院时未发现的医院获得性并发症将不再予以报销。这些变化将对住院治疗的报销产生深远影响。为了在新规则下尽量减少经济损失，医院和医生将不得不投入大量资源并予以关注，以改进病历记录。本文将讨论新的支付系统、医生在确保编码专家能够获取所有临床重要诊断方面的作用，以及可以采取的积极应对挑战的策略。
