reimbursement@wiki

 

DRG Info

• CMS Acute Inpatient PPS files (2005-2008)
• • FY 2009 Proposed Rule Table 5 - List of MS-DRGs, Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay
  • FY 2008 Final Rule Table 5 - List of MS-DRGs, Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay 

DRG worksheet calculators

• Calculating Hospital-Specific DRG Payments

• Calculating national average DRG payments

  • DRG = [standardized amounts (non-labor- and labor-related) x DRG relative weight (found at Table 5 of IPPS) + [capital rate x DRG relative weight)]

  • Double-check whether wage index is above/below 1

  • Excel file -- Medicare average MS-DRG payment amounts (from 2008)

Standardized Amounts and Capital Standard Federal Payment Rate (Tables 1A, 1B, and 1D)

	Labor Amt	Nonlabor Amt	Capital Rate
2008	$3,459.66	$1,503.98	$423.34
#	#	#	#

 

Online Medicare DRG Calculators

• IRP DRG Calculator
• Ingenix DRG Calculator

Criteria to be met to warrant creation of a CC or an MCC subgroup within a base MS-DRG (72 Fed Reg 47169)

1. A reduction in variance of charges of at least 3 percent. 
2. At least 5 percent of the patients in the MS-DRG fall within the CC or MCC subgroup. 
3. At least 500 cases are in the CC or MCC subgroup. 
4. There is at least a 20-percent difference in average charges between subgroups. 
5. There is a $4,000 difference in average charges between subgroups.

 

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