MS-DRG
Medical abbreviation · Health Insurance
| Stands for | Medicare Severity Diagnosis-Related Group |
|---|---|
| Categories | Medical |
MS-DRG stands for Medicare Severity Diagnosis-Related Group, a health insurance abbreviation.
Version of DRGs used by Medicare since fiscal year 2008, which splits many groups into tiers according to whether the patient has a major complication or comorbidity (MCC), a complication or comorbidity (CC) or neither. More severely ill patients generate higher payments.
Example: Documenting acute systolic heart failure added an MCC and moved the MS-DRG to a higher weight.
Usage notes
Each of the several hundred MS-DRGs has a relative weight updated annually. Clinical documentation integrity programs query physicians to clarify diagnoses that affect MS-DRG assignment. Some states and payers use other groupers, such as APR-DRGs, that also adjust for mortality risk.
Related abbreviations
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- MCO – Managed care organization
- MEC – Minimum essential coverage
- MIPS – Merit-based Incentive Payment System
- MLR – Medical loss ratio
- MOOP – Maximum out-of-pocket
- MPFS – Medicare Physician Fee Schedule
- MSP – Medicare Savings Program
- NCCI – National Correct Coding Initiative
- NCD – National coverage determination
- NCQA – National Committee for Quality Assurance
- NPI – National Provider Identifier
- NSA – No Surprises Act
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This entry is for general education and is not medical advice. Abbreviation use varies between institutions; always confirm in context.