- Medicare Severity Diagnosis Related Groups MSDRG Final Rule FR DRG
- Medicare Severity Diagnosis Related Groups MSDRG Final Rule FR Healthcare DRG
- Medicare Severity Diagnosis Related Groups MSDRG Final Rule FR CMS DRG
- DRG Codes
- Diagnosis Related Groups
- Diagnosis Group
- Healthcare DRG
- CMS DRG
- DRG Definition
Medicare Severity Diagnosis Related Groups MSDRG Final Rule
This dataset file includes the list of Medicare Severity Diagnosis-Related Groups (MSDRG) Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay Final Rule.
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Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). 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 resources used to treat Medicare patients in that DRG.
The base payment rate is divided into a labor-related and nonlabor share. The labor-related share is adjusted by the wage index applicable to the area where the hospital is located, and if the hospital is located in Alaska or Hawaii, the nonlabor share is adjusted by a cost of living adjustment factor. This base payment rate is multiplied by the DRG relative weight.
If the hospital treats a high-percentage of low-income patients, it receives a percentage add-on payment applied to the DRG-adjusted base payment rate. This add-on, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payment for hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients. For qualifying hospitals, the amount of this adjustment may vary based on the outcome of the statutory calculation.
Also, if the hospital is an approved teaching hospital it receives a percentage add-on payment for each case paid through IPPS. This add-on known as the indirect medical education (IME) adjustment, varies depending on the ratio of residents-to-beds under the IPPS for operating costs, and according to the ratio of residents-to-average daily census under the IPPS for capital costs.
Finally, for particular cases that are unusually costly, known as outlier cases, the IPPS payment is increased. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added to the DRG-adjusted base payment rate, plus any DSH or IME adjustments.
About this Dataset
2017 to 2021
John Snow Labs; Centers for Medicare and Medicaid Services;
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DRG, DRG Codes, Diagnosis Related Groups, Diagnosis Group, Healthcare DRG, CMS DRG, DRG Definition
Medicare Severity Diagnosis Related Groups MSDRG Final Rule FR DRG, Medicare Severity Diagnosis Related Groups MSDRG Final Rule FR Healthcare DRG, Medicare Severity Diagnosis Related Groups MSDRG Final Rule FR CMS DRG
|MSDRG||Medicare Severity Diagnosis Related Groups is a system of classifying a Medicare patient's hospital stay into various groups in order to facilitate payment of services.||string||-|
|Is_Final_Post_Acute_DRG||True or False for DRGs under special rules created for patients who are discharged immediately following their hospitalization to a rehab hospital, skilled nursing facility, a long-term care hospital or home health care.||boolean||-|
|Is_Final_Special_Pay_DRG||DRGs under special payment rule (True or False).||boolean||-|
|Major_Diagnostic_Category||The Major Diagnostic Categories (MDC) are formed by dividing all possible principal diagnoses from ICD-9-CM into 25 mutually exclusive diagnosis areas.||string||-|
|Type||Surgery or Medicine.||string||-|
|MSDRG_Title||DRG Diagnosis Related Group Description.||string||-|
|Weights||Relative Value Weights.||number||level : Ratio|
|Geometric_Mean_LOS||Geometric Mean Length of Stay.||number||level : Ratio|
|Arithmetic_Mean_LOS||Arithmetic Mean Length of Stay.||number||level : Ratio|
|Year||Year of the file (2017, 2018 and 2019)||date||-|
|MSDRG||Is Final Post Acute DRG||Is Final Special Pay DRG||Major Diagnostic Category||Type||MSDRG Title||Weights||Geometric Mean LOS||Arithmetic Mean LOS||Year|
|1||False||False||PRE||Surgery||HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC||27.1||30.0||38.6||2017|
|2||False||False||PRE||Surgery||HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC||16.15||18.1||22.2||2017|
|3||True||False||PRE||Surgery||ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.||17.95||25.3||31.9||2017|
|4||True||False||PRE||Surgery||TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.||10.93||20.1||24.4||2017|
|5||False||False||PRE||Surgery||LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANT||10.27||15.4||21.3||2017|
|6||False||False||PRE||Surgery||LIVER TRANSPLANT W/O MCC||4.81||7.7||8.5||2017|
|8||False||False||PRE||Surgery||SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT||5.49||9.3||10.6||2017|
|11||False||False||PRE||Surgery||TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC||5.0||11.5||14.3||2017|