How will the implementation of ICD-10-CM and ICD-10-PCS change the Medicare prospective payment systems (PPS)?
CMS has indicated that, initially, PPS case mix groups that rely on diagnosis and procedure codes (e.g., Medicare severity diagnosis-related groups, Home Health Resource Groups) may not fundamentally change. Mapping methodologies will be used to map the ICD-10-CM and ICD-10-PCS codes to the case mix group where the corresponding ICD-9-CM code was assigned. In cases when there is not a straightforward map, CMS will select the case mix group that is believed to be the “best fit.” Once CMS has collected sufficient claims data coded in ICD-10-CM and ICD-10-PCS, appropriate refinements will be made to the case mix groups as warranted.
Related Questions
- What does CMS believe the impact a Medicare Set-aside will have on the Medicare payment systems and procedures?
- After the implementation of ICD-10-CM and ICD-10-PCS, will providers stop reporting ICD-9-CM codes on claims?
- How might the implementation of ICD-10-CM and ICD-10-PCS be expected to impact quality reporting?
