Medicare Modernization of Payment Software

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS has provided MLN4761491 – Medicare Modernization of Payment Software Fact Sheet (5-pages in length) for providers submitting institutional claims to Medicare Administrative Contractors (MACs). It’s primarily for software vendors and others who support you with claims processing systems. If you use a software vendor, it’s important that your vendor knows about this modernization update.

CMS is modernizing its grouping and code editor software. Medicare processes all Original Medicare institutional claims through at least 1 of 3 sub-systems within the Fiscal Intermediary Shared System (FISS):

  • The Medicare Code Editor (MCE)  
  • The Inpatient Grouper (MS-DRG) 
  • The Integrated Outpatient Code Editor (I/OCE)

(CMS) expanded this modernization effort to include these additional software products:

• The Inpatient Rehabilitation Facility (IRF) Case-Mix Group (CMG) Grouper
• The Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Grouper
• Java Pricers 
• Web Pricers