Medicare Plans to Modernize Payment Grouping and Code Editor Software

The Centers for Medicare & Medicaid Services (CMS) is modernizing its grouping and code editor software. Medicare processes all Original Medicare institutional claims through one of three sub-systems within the Fiscal Intermediary Shared System (FISS): • The Medicare Code Editor (MCE) • The Inpatient Grouper (MS-DRG) • The Integrated Outpatient Code Editor (IOCE). These sub-systems are built with an antiquated programming language (Assembler) that is difficult to extend, maintain, support and test. Modernizing these programs will protect CMS from future quality and integration risks.

Conversion of the IOCE Given the complexity of the business logic and the high volume of claims affected by the IOCE, CMS plans to convert this program only after the successful conversion of the others. This will apply any lessons learned and best practices identified in the earlier stages to the IOCE. CMS plans to test a converted Java version of IOCE during 2022. A public version of this test software is expected to be available in July 2022. The fully converted Java re-write of the IOCE is planned for implementation with version 24, effective January 2, 2023. CMS will provide an Assembler version of version 24 to stakeholders in tandem with this implementation. Beginning with version 24.1 in April 2023, only the Java version of the IOCE will be available to stakeholders via the CMS website. At this point, CMS’ retirement of Assembler-based code editing and grouping software will be complete.

MLN Matters Number: SE19013

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE19013.pdf