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All Posts Tagged Tag: ‘DRG’

  • Medicare Readmission Reduction Calculation

    I came across a simple explanation of how CMS will calculate readmission reduction payments. Remember that the reduction applies to 3 categories: heart failure, acute myocardial infarction, and pneumonia. First, CMS tells us that the reductions are calculated using the excess readmission ratio, which is …

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  • Input Pricing Under the Prospective Payment System (PPS)

    As discussed in a precious article about PPS, we discussed labor, nonlabor, and capital costs. The purpose of this brief discussion is to explain the elements in more detail, especially because of its interrelationship with the wage index computed on S-3, Part II and Part …

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  • How to Calculate Operating DSH (Disproportionate Share Hospital)

    How to calculate the operating DSH adjustment One area that sometimes confuses providers is the operating DSH calculation. We know operating DSH is important due to the DRG calculation. 1. Urban hospitals with 100+ beds. 2. Rural hospitals with 500+ beds. 3. Rural hospitals that …

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  • Cost Outliers: A Brief Explanation of DRG Outliers (Part 1)

    Outlier payments are designed to compensate a facility for costs over and above normally expected costs. Remember that a DRG (diagnosis related group) payment is a reasonable estimate of what a single case (discharge) should cost. If a case becomes excessively expensive, then it makes …

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  • What is IPPS (inpatient prospective payment system) for Medicare?

    The purpose of the post is to briefly explain how to calculate operating and capital DRG (diagnosis related groups) payments. “Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average …

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