Hi Kate. DRGs groups represent combo meals. Its a way instead of paying everything fee for service, you determine what services patients get for these stays and puts a cost a patient is expected to get, so we don't have people ordering needless tests to rack up a hospital bill. If the final diagnosis justifies these expenses, the patient will have a higher cost of care. You shouldn't pay for extra cheese if you didn't ask for it..or 100 mcnuggets if you only ordered 10. .
I do have detailed information on DRGs in my Principles of Medical Reimbursement book if you would like for me so post up something a bit more detailed. But this is essentially the right idea of how they work. Here is a breakdown as how I understand it: -A hospital opens and starts taking on patients -Coders begin sending in reimbursement forms (which contain data on the types of patients and diagnoses that a hospital most often deals with.) *WHY CODERS MUST CODE ACCURATELY* This information tells the insurances "Hey! This is costing us $X.XX amount of money!" -Insurances look at the overall cost of caring for different diagnoses *DRGs* and determine umbrella rates per diagnosis (Example: Inpatient care for people who undergo open-heart surgery generally costs (we'll say) approx. $30,000 in care and resources. So therefore, EVERYONE person who is admitted to that hospital is allowed $30,000 in reimbursement for open-heart surgery.) If a patient exceeds that cost, the hospital loses money. If the patient uses less money, the hospital profits. -Case mixes help the hospital; patient A exceeded the cost of his reimbursement for his heart surgery. The hospital lost $5,000. BUT patient B used $9,000 LESS than their reimbursement rate for their surgery. 9,000 - 5,000 = 4,000 So, the hospital made a profit of $4,000 since patient B made up for the loss from patient A.
True, they are not. I went to college to learn coding from both AAPC & AHIMA programs and neither one concentrated on DRG's ( I-9 Volume 3 when I was in school). It is mostly a learn on the job deal.
We have DRG in Germany since 2004 and the total health costs did not become less. Hospitals now working like factories, aiming for maximum profit and releasing patients when the budget of their DRG is used up. Hospitals learned quickly how to take advantage of the DRG system, for example performing hundreds of useless operations each year. Which increase the total cost instead of cutting it.
I take the CCA exam on Friday, and I have the practice exam, and their are DRGs on those. I have no clue where to find them in my books at all. I have looked in all 3 of them. It talks about the DRG's but I cant find the codes for them.... HELP!!
I've wondered if Biller and Coder are covered by the same certifications? I am taking an online course from CareerStep (if that makes any diff) and they include a chapter on Reimbursement and all the Medicare stuff (it seems rather cursory though in what it covers). I've seen jobs where they advertise as "Biller/Coder" where I guess they expect you to handle both jobs and I've also seen where people are said to be working in the Billing department and they receive their coding from another department (I'd guess that would be a larger company where they split the two jobs). So, does Billing require additional training? Or if you get the standard Coding certifications does that make you a Biller also?
Phil Adams billing is a separate certification from Coding, but coders need to understand reimbursement because the sequencing of diagnosis codes impacts/affects/influences the amount the hospital is being reimbursed. If you put dx codes in an inaccurate sequence the hospital could be losing money or they could be overpaid by the insurance company. Even though coders don’t do any billing coders still have to understand how the their job dictates what the hospital will be paid back from the insurance company 😁
@@Oklahomajewel1 I just finished the Career Step course and let me tell you something: you don't get much help from your advocate or "instructors". Now, some people get lucky and are able to stay in contact with people who actually help them out, but if I didn't find this channel and Codemaster Coach on TH-cam, I'd be completely lost still. It's a good program as a whole, but I started studying in January of last year and the last time I heard from my advocate was in February. I know the advocate isn't there to help you figure out the codes, but they are there to help encourage you and help with any questions you might have. Like I said, some people get lucky, but unfortunately I was on my own. If I could have gone to an actual school and had other people around me to help bounce ideas and questions off of, I think I would have more confidence in this course. I had to do it online because I'm my dad's caregiver and need to stay at home with him.
@@codingwithkate3792 I am at IOT in Salem Oregon and I am about to graduate and take the NCCT and I will be certified for billing and coding with one program. yes it is two job but its one of those things that the right hand needs to know what the left hand is doing, so if and when a bill is denied for the wrong code the biller dependinging on the size of the clinic is sometimes responsible for fixing any errors that may have occurred and resubmitting the bill for payment to the third party payer or patient.
So... here is my dilemma. I'm studying for the CCS exam and I just read that I need to know MS-DRG's.. and I cannot for the life of me find it in any of the books?? How am I supposed to remember what all of them are? I have a chromebook and unfortunately, the encoder doesn't work so I have to look on my tablet which takes longer... is there a list I can find of all of them so I can write them down on flashcards or something? Sorry.... a little panicky right now.
rita bo bita I wish I could be of help with this topic but I still don’t understand MS-DRGs and outside of what’s in that reimbursement textbook, I still have no idea how to find the list of them, etc.
rita bo bita on the CCA, I believe there was only one question and I of course guessed the answer lol. But since you’re taking the CCS, I’d expect there to be a few more so I’d look at getting the CCS exam prep book and any of the reimbursement text books that will explain MS-DRGs
@@codingwithkate3792 I have all the books but the ccs book is already confusing to me. hopefully the more i work with it the better i'll be able to read the cases. ty for your help :)
Hi Kate. DRGs groups represent combo meals. Its a way instead of paying everything fee for service, you determine what services patients get for these stays and puts a cost a patient is expected to get, so we don't have people ordering needless tests to rack up a hospital bill. If the final diagnosis justifies these expenses, the patient will have a higher cost of care. You shouldn't pay for extra cheese if you didn't ask for it..or 100 mcnuggets if you only ordered 10. .
I do have detailed information on DRGs in my Principles of Medical Reimbursement book if you would like for me so post up something a bit more detailed. But this is essentially the right idea of how they work.
Here is a breakdown as how I understand it:
-A hospital opens and starts taking on patients
-Coders begin sending in reimbursement forms (which contain data on the types of patients and diagnoses that a hospital most often deals with.) *WHY CODERS MUST CODE ACCURATELY* This information tells the insurances "Hey! This is costing us $X.XX amount of money!"
-Insurances look at the overall cost of caring for different diagnoses *DRGs* and determine umbrella rates per diagnosis (Example: Inpatient care for people who undergo open-heart surgery generally costs (we'll say) approx. $30,000 in care and resources. So therefore, EVERYONE person who is admitted to that hospital is allowed $30,000 in reimbursement for open-heart surgery.) If a patient exceeds that cost, the hospital loses money. If the patient uses less money, the hospital profits.
-Case mixes help the hospital; patient A exceeded the cost of his reimbursement for his heart surgery. The hospital lost $5,000. BUT patient B used $9,000 LESS than their reimbursement rate for their surgery. 9,000 - 5,000 = 4,000 So, the hospital made a profit of $4,000 since patient B made up for the loss from patient A.
What books do you use for reimburements?
oh shit thanks so much I didn't understand it until I read this. I'm taking cna classes.
Why does the hospital loose $5,000?
@@dayannarubio8952 bc the cost of care
Oh my gosh, thanks for this one! It is difficult because DRG's are not covered much in coding classes. I know they are on the test though.
True, they are not. I went to college to learn coding from both AAPC & AHIMA programs and neither one concentrated on DRG's ( I-9 Volume 3 when I was in school). It is mostly a learn on the job deal.
I am taking a course in healthcare reimbursement next semester for the health information technology program
This came up when i searched drg for deep rock galactic
We have DRG in Germany since 2004 and the total health costs did not become less. Hospitals now working like factories, aiming for maximum profit and releasing patients when the budget of their DRG is used up. Hospitals learned quickly how to take advantage of the DRG system, for example performing hundreds of useless operations each year. Which increase the total cost instead of cutting it.
ROCK AND STONE!
Thank you. Thank you, I am graduating in Aug. Whenever I get stuck your videos help me a lot. I appreciate it sooo much.
Where did you go?
Very good Kate, your darling. This was very helpful. I wonder if you could sum up "ACA risk pools"
I take the CCA exam on Friday, and I have the practice exam, and their are DRGs on those. I have no clue where to find them in my books at all. I have looked in all 3 of them. It talks about the DRG's but I cant find the codes for them.... HELP!!
I've wondered if Biller and Coder are covered by the same certifications? I am taking an online course from CareerStep (if that makes any diff) and they include a chapter on Reimbursement and all the Medicare stuff (it seems rather cursory though in what it covers). I've seen jobs where they advertise as "Biller/Coder" where I guess they expect you to handle both jobs and I've also seen where people are said to be working in the Billing department and they receive their coding from another department (I'd guess that would be a larger company where they split the two jobs). So, does Billing require additional training? Or if you get the standard Coding certifications does that make you a Biller also?
Phil Adams billing is a separate certification from Coding, but coders need to understand reimbursement because the sequencing of diagnosis codes impacts/affects/influences the amount the hospital is being reimbursed. If you put dx codes in an inaccurate sequence the hospital could be losing money or they could be overpaid by the insurance company. Even though coders don’t do any billing coders still have to understand how the their job dictates what the hospital will be paid back from the insurance company 😁
Thanks. That makes perfect sense. I figured billing had to be much more complicated than they discussed in my class.
Phil, I've thought of taking the Career Step course . How do you like it? Have you finished? I'd love to hear from you.
@@Oklahomajewel1 I just finished the Career Step course and let me tell you something: you don't get much help from your advocate or "instructors". Now, some people get lucky and are able to stay in contact with people who actually help them out, but if I didn't find this channel and Codemaster Coach on TH-cam, I'd be completely lost still. It's a good program as a whole, but I started studying in January of last year and the last time I heard from my advocate was in February. I know the advocate isn't there to help you figure out the codes, but they are there to help encourage you and help with any questions you might have. Like I said, some people get lucky, but unfortunately I was on my own. If I could have gone to an actual school and had other people around me to help bounce ideas and questions off of, I think I would have more confidence in this course. I had to do it online because I'm my dad's caregiver and need to stay at home with him.
@@codingwithkate3792 I am at IOT in Salem Oregon and I am about to graduate and take the NCCT and I will be certified for billing and coding with one program. yes it is two job but its one of those things that the right hand needs to know what the left hand is doing, so if and when a bill is denied for the wrong code the biller dependinging on the size of the clinic is sometimes responsible for fixing any errors that may have occurred and resubmitting the bill for payment to the third party payer or patient.
What book did you read? Name title author
in which coding books are drg's found in?
So... here is my dilemma. I'm studying for the CCS exam and I just read that I need to know MS-DRG's.. and I cannot for the life of me find it in any of the books?? How am I supposed to remember what all of them are? I have a chromebook and unfortunately, the encoder doesn't work so I have to look on my tablet which takes longer... is there a list I can find of all of them so I can write them down on flashcards or something? Sorry.... a little panicky right now.
rita bo bita I wish I could be of help with this topic but I still don’t understand MS-DRGs and outside of what’s in that reimbursement textbook, I still have no idea how to find the list of them, etc.
@@codingwithkate3792 hmmm. did you have a lot of those questions on the exam you took?
rita bo bita on the CCA, I believe there was only one question and I of course guessed the answer lol. But since you’re taking the CCS, I’d expect there to be a few more so I’d look at getting the CCS exam prep book and any of the reimbursement text books that will explain MS-DRGs
@@codingwithkate3792 I have all the books but the ccs book is already confusing to me. hopefully the more i work with it the better i'll be able to read the cases. ty for your help :)
Can you do a video on sequencing? That would be so helpful.
you were amazing n thank you !
Thanks for your sharing.
OOO.....100th like.......
Am attending coding interview tomorrow.
This isnt a eliet deep dive
Siggy brought me here wtf.....diss god DRG where your vids
wala may ga like pigado