PB2008-500036 Report Nos: Title: CMS Medicare Severity Grouper Software with Medicare Code Editor (MS-DRG/MCE) Version 25.1 (software distributed on CD-ROM). Date: 1 Apr 2008 Performing Organization: Health Care Financing Administration, Baltimore, MD.**Centers for Medicare and Medicaid Services, Baltimore, MD. Type of Report and Period Covered: Software. Availability: The software is on one CD-ROM disc. Documentation on CD-ROM is included or may be ordered separately as PB2008-100845. Hardware and software requirements: Windows 98/NT 4.0 service pack 6/2000 (service pack 3); and XP - 50 MB of hard disk space with at least 16Mb of RAM. Number of Pages: CD-ROM disc Keywords: *Diagnosis related groups, *Medicare, *Severity, *Claims, *Error detection codes, *Software, Administration, Classification systems, Patients, Demography, Hospitals, Discharge(Health facilities), Billing, Health care costs, Coding, Claim review, Health insurance, Magnetic tape, Cartridge, *CMS(Centers for Medicare and Medicaid Services), CMS Grouper Software/Medicare Code Editor(CMSG/MCE), Medicare Severity Diagnosis Related Groups(MS-DRG). Abstract: The MS-DRG V25.1 software adds a new Patient Status Discharge Code 70 to define Discharges or Transfers to Other Types of Health Care Institutions not defined elsewhere in the UB-04 Manual Code List and a definition change to existing patient discharge status code 05. The MS-DRG Grouper software provides a new calling interface designed to support not only the new fields and results from MS-DRGs but also anticipated grouper inputs and outputs for future versions that would include such changes as present on admission. The software also uses new technology and offers a utility program (D250UT) plus two Cobol interfaces: The standard interface (D250CN), which would be called from Cobol or Assembler, and the new alternate interface (D250CA) which takes two additional run-time parameters provided by the calling program a 20K work area and a length variable. It uses no operating system macros and is re-entrant. Users should be able to integrate it into virtually any mainframe environment without having to modify any grouper source code. The objective with these two interfaces is to provide compatibility with the previous standard interface, and an easier method of accommodating users who need re-entrant code with the alternate interface. Centers for Medicare and Medicaid Services (formerly Health Care Financing Administration) Grouper with Medicare Code Editor (CMSG/MCE) software edits medical record data to help identify coding errors, and inconsistencies between clinical data and coding. The software: (1) Assigns the medical record to a Major Diagnostic Category (MDC) and a Diagnosis Related Group (DRG); (2) Displays clinical edits that identify inconsistencies after evaluating a patient's principal diagnosis, any secondary diagnoses, surgical procedures, age, sex, and PB2008-500036 Continued... discharge status for possible errors; (3) Displays the cost weight associated with the assigned DRG for each patient record; and (4) Processes medical record data either from a MS-DOS batch file or interactively in a Windows environment. The program automatically calls the appropriate CMS grouper to process the claim based on the groupers installed and the discharge date entered on the patient record.