Guides
Guides
Practical guides on MS-DRG grouping, clinical documentation, and Medicare reimbursement — every example runs on real FY2026 CMS data, and you can price it yourself in the calculator.
The guides
- Clinical Documentation
CC vs MCC: How One Diagnosis Changes the MS-DRG (and the Payment)
A single documented MCC can nearly double a DRG's relative weight. Here's how CCs and MCCs drive MS-DRG severity splits — with a worked sepsis example (DRG 871 vs 872) on real FY2026 weights.
- Healthcare Billing
POA Indicators: How Present-on-Admission Status Impacts MS-DRG Reimbursement
Present-on-Admission (POA) indicators decide whether a CC/MCC counts toward your DRG — or gets stripped out under Medicare's Hospital-Acquired Conditions program. A breakdown of the Y/N/U/W codes and the payment impact.
- Outpatient Pricing
How to Calculate the Outpatient OPPS vs ASC Site-of-Service Differential
The exact CMS formulas for the payment gap between a Hospital Outpatient Department (OPPS/APC) and an Ambulatory Surgical Center (ASC), with a worked CY2026 colonoscopy example.