In an effort to further refine the diagnosis-related group (DRG) system, the Centers for Medicare and Medicaid Services will adopt a new classification system for Medicare’s hospital inpatient prospective payment systems (IPPS), the Medicare Severity DRG (MS-DRG) classification system, effective for dates of discharge on and after October 1, 2007. As a result of these changes, Medicare Grouper Version 25 will be implemented.
Implementation of Medicare Grouper Version 25
BadgerCare Plus will implement Medicare Grouper Version 25 for dates
of discharge on and after July 1, 2008. For dates of discharge before
July 1, 2008, BadgerCare Plus will continue to process claims using
diagnosis-related groups (DRGs) included in Medicare Grouper Version 24.
Medicare Grouper Version 25 contains substantial revisions from Medicare
Grouper Version 24 as a result of the CMS adoption of the Medicare
Severity DRG (MS-DRG) classification system. Additional information
regarding the new MS-DRG classification system was published in the
Federal Register on August 22, 2007, and can be found at
www.cms.hhs.gov/quarterlyproviderupdates/downloads/
cms1533fc.pdf.
Any interim information regarding the conversion of the BadgerCare Plus
DRG system to the new grouper version will be made available at
dhs.wisconsin.gov/medicaid4/drg/drg.htm.
The information in this BadgerCare Plus Update applies to the BadgerCare Plus Standard Plan and Benchmark Plan.
Information Regarding Managed Care
This Update contains fee-for-service policy and applies to services members receive on a fee-for-service basis only. For managed care policy, contact the appropriate managed care organization. BadgerCare Plus HMOs are required to provide at least the same benefits as those provided under fee-for-service arrangements.
