The CMS is recommending approval of a new DRG for heart failure patients who qualify for an implantable cardioverter defibrillator (ICD). The proposed DRG provides higher reimbursement for patients with more than one illness and is included in the proposed hospital inpatient payment rates for fiscal 2004, according to Guidant Corp. Officials at the Indianapolis-based medical device manufacturer said they first proposed the new DRG to the CMS about two years ago. Under the proposal, Medicare would reimburse at a base rate of $39,000. Hospitals are now reimbursed roughly $30,000 for ICD patients who do not also suffer from heart failure, said Jay Stracke, Guidant's manager of reimbursement and economics for rhythmic management. Stracke added that it is unclear how many patients will fall under the new DRG, but the intent of the proposal was to make the reimbursement for ICDs more consistent with those of pacemakers and other procedures. The proposed rates for inpatient hospital services for 2004 are subject to a 60-day public comment period. The final rule is expected to be issued in August, and if approved, will take effect on Oct. 1. Complete proposed rates are posted here. -- by Cinda Becker
CMS recommends approval of new DRG
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