February 17, 2011

DRG Modifier Tool

e-Medtools is providing, as a public service, a free abbreviated list of DRG Modifiers that qualify as Major Complications and Comorbid Conditions (MCC) & Complications and Comorbid Conditions(CC) as defined by the Centers for Medicare & Medicaid (CMS).

These MCCs and CCs are important to every healthcare provider because they help hospitals maximize reimbursement in accordance with the appropriate level of severity of illness for a given patient. Every healthcare provider deserves to be paid appropriately for services provided. Healthcare is a team effort, and every member of the healthcare team owes it to themselves, their colleagues and their patients to work together for mutual benefit.

At a time when Medicare continues to decrease reimbursement to all healthcare providers, it is more important than ever to work diligently to educate ourselves on navigating an increasingly complex reimbursement system. Hospitals play a important role in every community. Hospitals routinely provide free access to healthcare without regard to ability to pay for services rendered. Hospitals are often major employers in communities, and are often integral to community support efforts. It is therefor critical to support hospitals by every possible means to ensure that they can receive payment appropriate for the level of care provided.

One important note: MCCs and CCs use terminology specific to the CMS, and MUST be documented by a healthcare practitioner, preferentially in the Discharge Summary.

Medicare regulations prohibit Hospitals from providing this information to healthcare providers. Please consider reviewing this form, print as many copies as you like, and check all that apply and include this information in your patient documentation.

We hope that you find this information helpful, and we look forward to your feedback.

The Folks at e-MedTools, creators of MedicalTemplates, MedSpel, E/M Code Check and iRVU

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