MLN Product (Revised); Title: Medicare Modernization of Payment Software
This revised Product comprises Subregulatory Guidance for CMS’s modernization of 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), and The Integrated Outpatient Code Editor (I/OCE). These sub-systems use an outdated programming language (Assembler) that’s difficult to extend, maintain, support, and test. Modernizing these programs will protect CMS from future quality and integration risks. This product educates providers on submitting institutional claims to the Medicare Administrative Contractors (MACs). It will help the software vendors and others (who support providers with claims processing systems) understand this payment software modernization. CMS policy or operation subject matter experts also reviewed/cleared this product. Revisions to this Product include following content updates:
• added link for the updated version of the ICD-10 MS-DRG Grouper Software and MCE ICD-10 Software on page 2
• added information on Java Pricers and Web Pricers on pages 1,3 and 4
• Updated Java Conversion Schedule Summary table on page 5
The previous version of this Product is available to the public and currently posted on the CMS website at: https://www.cms.gov/files/document/medicare-modernization-payment-software.pdf.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: March 24, 2022
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.