The Centers for Medicare & Medicaid Services (CMS) is proactively updating the Medicare Severity Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) software to ensure compatibility with the latest technology standards. For healthcare providers and software vendors utilizing these essential tools, understanding these changes and preparing for them is crucial. This article breaks down the key updates, focusing on the upcoming Java 17 conversion and how you can leverage freely available test versions, effectively acting as a “demo free” experience, to navigate these transitions smoothly.
Understanding the MS-DRG and MCE Software Transition
Currently, the MS-DRG Grouper and MCE software operate on Java version 8. As support for Java 8 is slated to end in November 2026, CMS is undertaking a necessary upgrade to Java version 17. This shift will primarily affect hospitals and software vendors who have integrated these programs within mainframe environments.
To facilitate a seamless transition, CMS is adopting a phased approach. For the Fiscal Year 2025 releases, effective October 2024, two Common Business-Oriented Language (COBOL) Java bridge modules will be included. One module will maintain compatibility with the existing 31-bit, Java 8 Java Virtual Machine (JVM), ensuring continued functionality for current systems. Simultaneously, a new bridge module compatible with the 64-bit, Java 17 JVM will be provided. Importantly, both Java jar files will initially be compiled using Java 8 to preserve backward compatibility for existing mainframe deployments, both batch and Customer Information Control System (CICS).
This dual-module approach is designed to provide a testing period. Healthcare organizations can utilize the next year to evaluate and upgrade their systems in preparation for the full transition to Java 17. Installation guides accompanying the program releases will detail these changes, offering clear instructions for users.
Looking ahead to the Fiscal Year 2026 release, effective October 2025, the software will be fully compiled with Java 17. Only the Java 17, 64-bit COBOL calling module will be distributed at that point. Therefore, CMS strongly advises providers and software vendors to commence planning this year to ensure readiness for this essential conversion in the fall of 2025.
For any queries regarding the Java 17 conversion, CMS encourages stakeholders to reach out to the dedicated resource mailbox: [email protected].
The Foundation of MS-DRGs in Healthcare Reimbursement
The MS-DRG system is integral to the Inpatient Prospective Payment System (IPPS). Established under Section 1886(d) of the Act, it serves as a classification framework for inpatient discharges. Payments under IPPS are adjusted based on weighting factors assigned to each DRG, reflecting the average resources needed to care for patients within that specific DRG relative to all others.
This system allows for a standardized and resource-based payment structure for inpatient hospital services. The payment calculation involves multiplying a hospital’s individual payment rate per case by the DRG weight assigned to the patient’s stay. Each DRG weight acts as a measure of the average resources utilized for cases within that particular DRG.
Recognizing the dynamic nature of healthcare, Congress mandated periodic recalculations of DRG relative weights. Section 1886(d)(4)(C) of the Act necessitates annual adjustments to DRG classifications and weights. These adjustments accommodate evolving treatment patterns, technological advancements, and other factors influencing hospital resource utilization.
Currently, MS-DRG assignment relies on data reported by hospitals, including the principal diagnosis, up to 24 secondary diagnoses, and up to 25 procedures performed during the inpatient stay. In certain MS-DRGs, patient demographics like age, sex, and discharge status are also considered. Since October 1, 2015, hospitals report diagnosis and procedure information using codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).
For deeper insights into the MS-DRG system, including annual reviews and modifications, CMS provides access to prior Inpatient Prospective Payment System (IPPS) proposed and final rules, readily available on their website. For MS-DRG related inquiries, the [email protected] mailbox remains a valuable resource.
Exploring MS-DRG Software: Your “Demo Free” Access
CMS provides various versions of the MS-DRG Grouper software for users to understand and analyze the impact of proposed rule changes. These test versions act as a “demo free” environment, allowing healthcare professionals and software developers to familiarize themselves with the software’s logic and functionality without any cost.
Test Versions and Draft Files:
CMS routinely releases test versions and draft files of the MS-DRG Grouper software in conjunction with proposed rules for the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS). These releases are invaluable resources for understanding the implications of proposed changes.
For example, the “FY 2025 – Version 42 Test GROUPER – DRAFT file for FY 2025 IPPS/LTCH PPS Proposed Rule” and the “FY 2024 – Version 41 Test GROUPER – DRAFT file for FY 2024 IPPS/LTCH PPS Proposed Rule” are specifically designed to help the public analyze the impact of proposals related to NonCC Subgroup Criteria and other FY updates.
These test versions mirror the proposed GROUPER logic for the respective fiscal years, offering a practical way to assess how changes might affect coding and reimbursement. Accompanying these software releases are draft versions of the Definition of Medicare Code Edits and the ICD-10 MS-DRG Definitions Manual, providing comprehensive documentation for users.
Accessing and Utilizing the Software:
The software and associated files are typically available as downloadable ZIP files. CMS provides both Java Source Code (JAR files) and precompiled jar files. While the source code is primarily for transparency and deeper insight into the software’s methodology, the precompiled jar files are readily usable on any platform running Java. Instructions are also provided to guide users through the setup and utilization process.
By exploring these “demo free” test versions, medical coders, healthcare administrators, and software vendors can gain hands-on experience with the MS-DRG Grouper software, understand its logic, and prepare for official updates and changes in medical coding practices. This proactive approach ensures smoother transitions and more accurate medical coding and billing processes.
Staying Updated with MS-DRG Changes
CMS provides a dedicated “Latest News” section with links to recent updates and software releases. This section is regularly updated with links to documents and software related to the ICD-10 MS-DRGs and the IPPS. Monitoring this section ensures you remain informed about the most current versions, effective dates, and any errata or updates.
Requesting MS-DRG Classification Changes:
For stakeholders who wish to propose annual MS-DRG classification changes, CMS has streamlined the submission process through the Medicare Electronic Application Request Information SystemTM (MEARISTM). Effective April 5, 2022, this electronic intake system is the sole channel for submitting these requests. Requests sent via the [email protected] mailbox are no longer considered. The MEARISTM system can be accessed at: https://mearis.cms.gov.
Conclusion: Prepare for the Future of MS-DRG Coding
The upcoming Java 17 conversion for the MS-DRG Grouper and MCE software represents a significant update for healthcare organizations utilizing these systems. CMS is committed to providing the resources and lead time necessary for a smooth transition. By leveraging the “demo free” test versions of the software, staying informed through official CMS channels, and proactively planning for the Java 17 update, healthcare providers and software vendors can ensure continued compliance and efficiency in medical coding and healthcare management. Embrace these resources and prepare your systems today for the future of MS-DRG coding.
