Although the DRG grouper is updated on October 1 each year due, concurrent with changes to the ICD coding manual, the payment schedule is updated according to the facility's Participating Agreement. HMSA reserves the right to update the DRG payment schedule at other times during the year as necessary.

How often are DRG codes updated?

Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually. These adjustments are made to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources.

How are DRG codes determined?

DRGs are defined based on the principal diagnosis, secondary diagnoses, surgical procedures, age, sex and discharge status of the patients treated. Through DRGs, hospitals can gain an understanding of the patients being treated, the costs incurred and within reasonable limits, the services expected to be required.