Diagnosis Related Groups and Classifications

This data package contains the Diagnosis Related Groups (DRGs) patient classification system that provides a means of relating the type of patients a hospital treats to the costs incurred by the hospital. Capital Ratios for Acute Care Hospitals are used to determine whether a case qualifies for outlier payments under the hospital inpatient prospective payment system (IPPS), hospital-specific cost-to-charge ratios are applied to the total covered charges for the case. Operating and capital costs for the case are calculated separately by applying separate operating and capital cost-to-charge ratios and combining these costs to compare them with the fixed-loss outlier threshold.

Case Mix Index And Wage Index Table By CMS Certification Number (CCN) Correction Notice dataset contains the correction notice of Wage Index Final Rule Table 2. Table lists each Lugar hospital that is located in a county that qualifies for an outmigration adjustment; the 3-year period for which the hospital is eligible for the outmigration adjustment; and whether or not the hospital accepted the outmigration adjustment in lieu of its urban status for each year of its 3-year eligibility. A Diagnosis-Related Group dataset contains a list of Medicare Severity (MS) DRG with a specification of the Major Diagnostic Category (MDC) and whether the MS-DRG is medical or surgical. Some MS-DRGs which contain patients from multiple MDCs do not have an MDC specified. Diagnosis-Related Group is a statistical system of classifying any inpatient stay into groups for the purposes of payment.

The Hospital-Acquired Conditions (HACs) are conditions that occur after the physician writes the inpatient admission order and that could have been reasonably prevented through the application of evidence-based guidelines and best practices. The dataset Major Diagnostic Categories contains all 25 MDCs along with the DRGs assigned to each MDC. The data is organized by MDC with a list of the surgical classes associated with that MDC listed in hierarchical order as well as the MS-DRGs that are included in each surgical class. This dataset contains the final rule/correction notice cost thresholds by Medicare Severity Diagnosis Related Group (MS-DRG) for the cost criteria for new technology add on payment applications for FY 2018.

The dataset Operating Ratios for Acute Care Hospitals contains the Fiscal Year 2017 Inpatient Prospective Payment System (IPPS) operating and capital statewide average cost-to-charge-ratios. The empty values mean that all counties in the State or Territory are classified as urban. This dataset Percentile Lengths of Hospital Stay consists of a table containing Medicare Prospective Payment System Selected Percentile Lengths of Stay for FY 2015. The dataset Statewide Average Ratios contains the Fiscal Year 2017 IPPS operating and capital statewide average cost-to-charge ratios. It also includes States with no data from hospitals paid under the IPPS where the national average IPPS total rural CCR for the rural statewide average is used for these areas.

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1. APR-DRG Service Intensity Weights and Average Length of Stay

This dataset is the version 33 of APR-DRG Weights (All Patient Refined Diagnosis Related Group) and ALOS (Average Length of Stay) for acute care services. The APR-DRG weights effective January 1, 2017 will not be updated. For discharges beginning on or after January 1, 2018, the SIWs (Service Intensity Weights), cost thresholds and ALOS effective July 1, 2014 will be used for payment purposes with the updated APR-DRG grouper version 33, which is available in this dataset.

2. Capital Ratios For Acute Care Hospitals

This dataset is used to determine whether a case qualifies for outlier payments under the hospital inpatient prospective payment system (IPPS), hospital-specific cost-to-charge ratios are applied to the total covered charges for the case. Operating and capital costs for the case are calculated separately by applying separate operating and capital cost-to-charge ratios and combining these costs to compare them with the fixed-loss outlier threshold.

3. Case Mix Index And Wage Index Table By CCN Correction Notice

This dataset contains the correction notice of Wage Index Final Rule. It lists each Lugar hospital (deemed urban under section 1886(d)(8)(B) of the Act) that is located in a county that qualifies for an outmigration adjustment; the 3-year period for which the hospital is eligible for the outmigration adjustment; and whether or not the hospital accepted the outmigration adjustment in lieu of its urban status for each year of its 3-year eligibility.

4. Case Mix Index And Wage Index Table By CCN Final Rule

This dataset contains the non-transfer adjusted Case Mix Index (CMI) based on the Medicare Severity Diagnosis Related Groups (MS-DRGs) billed on the claim in the year the claim was incurred.

5. Diagnosis Related Groups According to Procedure

This dataset contains a list of Medicare Severity Diagnosis Related Groups (MS-DRGs) with a specification of the Major Diagnostic Category (MDC) and whether the MS-DRG is medical or surgical. Some MS-DRGs which contain patients from multiple MDCs (e.g., 014 Allogeneic Bone Marrow Transplant) do not have an MDC specified.

6. Diagnosis Related Groups Assigned to Hospital Acquired Conditions

The following dataset consists of Hospital-Acquired Conditions (HACs) which are conditions that occur after the physician writes the inpatient admission order and that could have been reasonably prevented through the application of evidence-based guidelines and best practices.

7. Diagnosis Related Groups Assigned to Major Diagnostic Categories

This dataset contains all 25 MDCs (Major Diagnostic Categories), along with the DRGs assigned to each MDC. The data is organized by MDC with a list of the surgical classes associated with that MDC listed in hierarchical order as well as the MS-DRGs that are included in each surgical class.

8. Hospitals With Fewer Than 1600 Medicare Discharges And Potential

This dataset was taken from the United States Food and Drugs Association (US FDA).The datset is a list of Hospitals with Fewer than 1,600 Medicare Discharges Based on the December 2017 Update of the FY 2016 MedPAR File and Potentially Eligible Hospitals’ FY 2018 Low-Volume Hospital Payment Adjustment. Eligibility for the low-volume hospital payment adjustment is also dependent upon meeting the mileage criteria specified at 412.101(b)(2)(ii) of the regulations.

9. Medicare Severity Diagnosis Related Groups MSDRG Correction Notice

This dataset file includes the list of Medicare Severity Diagnosis-Related Groups (MS-DRGS) Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay Correction Notice.

10. 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.

11. Medicare Uncompensated Care Payment Final Rule

This dataset shows section 3133 of the Affordable Care Act as it amends the Medicare Disproportionate Share Hospital (DSH) adjustment provision under section 1886(d) (5) (F) of the Act, and establishes 1886(r) which provides for an additional payment for a hospital’s uncompensated care. As proposed in the FY 2014 IPPS proposed rule, the regulations that implement this provision are in proposed subpart I of 42 CFR part §412.106.

12. New Technology Add On Payments Thresholds Final Rule

This dataset contains the final rule/correction notice cost thresholds by Medicare Severity Diagnosis Related Group (MS-DRG) for the cost criteria for new technology add on payment applications for applications for FY 2018.

13. Operating Ratios For Acute Care Hospitals

This dataset contains the Fiscal Year 2017 Inpatient Prospective Payment System (IPPS) operating and capital statewide average cost-to-charge-ratios. The empty values mean that all counties in the State or Territory are classified as urban.

14. Percentile Lengths of Hospital Stay for MSDRG

This dataset consists of a table containing Medicare Prospective Payment System Selected Percentile Lengths of Stay for the fiscal year 2016, 2017, 2018, 2019 & 2020.

15. Statewide Average Ratios

This dataset contains the Fiscal Year 2017 Inpatient Prospective Payment System (IPPS) operating and capital statewide average cost-to-charge-ratios. The empty values mean that all counties in the State or Territory are classified as urban. It also includes States with no data from hospitals paid under the IPPS where the national average IPPS total rural CCR for the rural statewide average are used for these areas.

16. Wage Index Table By CBSA Correction Notice

This dataset contains the correction notice for Wage Index. The dataset lists each Lugar hospital (deemed urban under section 1886(d)(8)(B) of the Act) that is located in a county that qualifies for an outmigration adjustment; the 3-year period for which the hospital is eligible for the outmigration adjustment; and whether or not the hospital accepted the outmigration adjustment in lieu of its urban status for each year of its 3-year eligibility.

17. Wage Index Table By CBSA Final Rule

This dataset lists Final Rule Wage Index Table by Core-Based Statistical Areas (CBSAs). The wage index reflects the geographic reclassification of hospitals to another labor market area in accordance with sections 1886(d)(8)(B) and 1886(d)(10) of the Act.

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