Skip to main content

Medicare Part A and DRG’s

  • Chapter
  • First Online:
Principles of Coding and Reimbursement for Surgeons

Abstract

Physician reimbursement has historically been directly related to CPT codes and relative value units. But with the increasing relationship between hospitals, healthcare systems, and surgeons, it becomes even more important for us to understand how our own hospital practice and documentation can effect hospital reimbursement.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Charles AG, et al. The employed surgeon: a changing professional paradigm. JAMA Surg. 2013;148(4):323–8.

    Article  PubMed  Google Scholar 

  2. Vladeck B, Van de Water PN, Eichner J. Strengthening Medicare’s role in reducing racial and ethnic health disparities. Washington, DC: National Academy of Social Insurance; 2006.

    Google Scholar 

  3. The Henry J. Kaiser Family Foundation. The facts on Medicare spending and financing. 2015.

    Google Scholar 

  4. Mayes R. The origins, development, and passage of Medicare’s revolutionary prospective payment system. J Hist Med Allied Sci. 2007;62(1):21–55.

    Article  PubMed  Google Scholar 

  5. Marmour T. Political analysis and American Medical Care. Cambridge: Cambridge University Press; 1983.

    Google Scholar 

  6. Starr P. The social transformation of American medicine: the rise of a sovereign profession and the making of a vast industry. New York: Basic Books; 1982.

    Google Scholar 

  7. Stevens R. In sickness and in wealth: American Hospitals in the twentieth century. Johns Hopkins University Press, Baltimore and London; p. 284.

    Google Scholar 

  8. Executive Office of the President’s Council on Wage and Price Stability Staff. The rapid rise of hospital costs. 1977, President’s Council on Wage and Price Stability. p. 9–11.

    Google Scholar 

  9. Congressional Budget Office. Hospital cost containment model: a technical analysis. Washington, DC: GPO; 1981.

    Google Scholar 

  10. Averill R, et al. Autogrp: an interactive computer system for the analysis of health care data. Med Care. 1976;14:603–15.

    Article  PubMed  Google Scholar 

  11. Hsiao WC, Dunn DL, Weiner SL. Lessons of the New Jersey DRG payment system. Health Aff. 1986;5(22):32–45.

    Article  CAS  Google Scholar 

  12. Iglehart J. The new era of prospective payment for hospitals. N Engl J Med. 1983;308:1288–92.

    Google Scholar 

  13. Acute Inpatient PPS. 2015. [cited 2015 December 6, 2015]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html.

  14. Bushnell B. The evolution of DRGs. AAOS Now. 2013.

    Google Scholar 

  15. Center for Medicare and Medicaid Services. FY 2015 final rule tables. 2014 [cited 2015; FY 2015 Final Rule Tables]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2015-IPPS-Final-Rule-Home-Page-Items/FY2015-Final-Rule-Tables.html.

  16. Center for Medicare and Medicaid Services. FY 2016 final rule and correction notice tables. 2015; FY 2016 Final Rule and Correction Notice Tables]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2016-IPPS-Final-Rule-Home-Page-Items/FY2016-IPPS-Final-Rule-Tables.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending.

  17. Guidi TU. Medicare’s hospital outpatient prospective payment system: OPPS 101 (part 1 of 2). J Oncol Pract. 2010;6(6):321–4 4p.

    Article  PubMed Central  Google Scholar 

  18. Guidi TU. Medicare’s hospital outpatient prospective payment system: OPPS 101 (part 2 of 2). J Oncol Pract. 2011;7(1):57–60 4p.

    Article  PubMed Central  Google Scholar 

  19. Mathews AW. When hospital fees catch you off guard. In: Wall Street Journal. New York: Wall Street Journal; 2009.

    Google Scholar 

  20. Worth T. Hospital facility fees: why cost may give independent physicians an edge. Med Econ. 2014. Available from: http:medicaleconomics.modernmedicine.com/medical-economics/content/tags/facility-fees/hospital-facility-fees-why-cost-may-give-independent-ph?page=full%> internal-pdf://0719885378/AHA_on_facility_fees_2014_MedEcon.pdf

    Google Scholar 

  21. Schulte F. CMS takes aim at “facility fees”: rule would replace five code prices with flat rate. In: Modern healthcare. Chicago: Crain Communications, Inc; 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John T. Preskitt MD, FACS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Preskitt, J.T. (2017). Medicare Part A and DRG’s. In: Savarise, M., Senkowski, C. (eds) Principles of Coding and Reimbursement for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-319-43595-4_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43595-4_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43593-0

  • Online ISBN: 978-3-319-43595-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics