Ingenix’s MM APS-DRGs solution enables hospitals to prepare
for CMS’ implementation of severity-adjusted reimbursement
EDEN PRAIRIE , Minn. , February 22, 2007 — Ingenix, a leading health information company, today announced that it is offering a free evaluation license for its MM APS-DRGs ™ (Medicare Modified All-Payer Severity-Adjusted Diagnosis Related Groups) severity-adjusted reimbursement solution to hospitals, managed-care plans and hospital associations. Ingenix is offering the free evaluation license to help the health care industry gain an advanced understanding of using severity-adjusted reimbursement, and to allow organizations to study one of the methodologies that CMS is considering for implementation on October 2007 prior to the public comment period, which is expected to begin in May when the Notice of Proposed Rule Making is published.
“It’s essential for the industry to provide feedback to CMS on proposed changes to health care reimbursement. By providing MM APS-DRGs prior to implementation, interested parties can take the time to analyze the details of the methodology, assess financial and operational issues and provide quantitative input to CMS,” said David Ostler, executive vice president of the business solutions group at Ingenix. “In addition, the MM APS-DRGs methodology is an ideal learning tool for hospitals. It is a fully transparent methodology that builds on the current DRG system and will allow hospitals and the public to easily make the transition from the current DRG system to a severity-adjusted system.”
A key issue with any severity system is how the presence of specific secondary conditions, as well as combinations of conditions, impacts reimbursement. No matter what severity system CMS adopts, hospitals that are able to code completely and accurately, capturing all secondary and relevant conditions, will win. Hospitals can use MM APS-DRGs to do an initial evaluation of how well they are doing today, and get ahead of the learning curve.
CMS is expected to begin its phase-in of severity-adjusted reimbursement in October, which means that coders will need to quickly learn the nuances of the new reimbursement model preventing productivity losses that can impact hospital cash flow. Under the proposed severity-adjusted reimbursement model, payments to hospitals are based on hospital costs and the severity of the patient’s condition. Severity is represented by the presence of additional specific conditions, beyond those that primarily brought the patient to the hospital for treatment.
The Ingenix MM APS-DRGs solution enables hospitals to predict care delivery costs based on how sick the patient is and provides the foundation for payers and providers to implement severity-adjusted reimbursement. MM APS-DRGs analyze clinical data to classify patients | 
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