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How are DRGs developed and calculated?
Calculating DRG payments involves a formula that accounts for the adjustments discussed in the previous section. The DRG weight is multiplied by a “standardized amount,” a figure representing the average price per case for all Medicare cases during the year.
How do you calculate MS-DRG?
To figure out how much money your hospital got paid for your hospitalization, you must multiply your DRG’s relative weight by your hospital’s base payment rate. Here’s an example with a hospital that has a base payment rate of $6,000 when your DRG’s relative weight is 1.3: $6,000 X 1.3 = $7,800.
What is DRG pricing?
The DRG prices represent the relative costliness of inpatient hospital services provided to Medicare beneficiaries. Since the implementation of this prospective payment system (PPS), the DRG prices have been based on both estimated costs and charges.
How many DRGs are there in 2020?
278 DRGs
For 2020, there are only 278 DRGs that will be impacted by the transfer policy. This represents a drop in 2 DRGS that will be impacted by the rule. Based on the final rule to revise the MS-DRG classifications and on the additional ICD-10 codes, there were changes to the DRGs impacted by the transfer policy.
How to figure out how much your hospital got paid for your DRG?
To figure out how much money your hospital got paid for your hospitalization, you must multiply your DRG’s relative weight by your hospital’s base payment rate. Here’s an example with a hospital that has a base payment rate of $6,000 when your DRG’s relative weight is 1.3: $6,000 X 1.3 = $7,800.
How are DRG rates determined by the CMS?
The CMS selects the DRG based on the diagnosis that got the patient admitted to the hospital, any secondary diagnoses, the procedures the hospital performed, and the patient’s status when she checks out. Age and sex may also factor in. To start its calculations, the CMS sets basic labor and non-labor payments for a hospital stay.
How does Medicare’s DRG prospective payment system work?
In this DRG prospective payment system, Medicare pays hospitals a flat rate per case for inpatient hospital care so that efficient hospitals are rewarded for their efficiency and inefficient hospitals have an incentive to become more efficient.
How is the relative weight of a DRG determined?
Each DRG is assigned a relative weight based on the average amount of resources it takes to care for a patient assigned to that DRG. You can look up the relative weight for your particular DRG by downloading a chart provided by the Centers for Medicare and Medicaid Services following these instructions: