All information in
this report is taken from the Medicare Provider Analysis and
Review (MedPAR)
file which is updated annually by
CMS
based on the federal
fiscal year. The file includes billing data for 100% of
all Medicare fee-for-service claims (IPPS claims) for discharges during the
twelve months ending September 30. The report is
based on the most recent periods available and is consistent with
CMS
Data Release policies.
Please note that
MS-DRGs
introduced in FY08 are not compatible with prior
DRGs. Also please note that
"Average Payment" for
MS-DRGs
is different than "Average Reimbursement" that was reported for
DRGs.
- IPPS Cases
- total number of IPPS claims for the Base
MS-DRG.
IPPS claims are Medicare fee-for-service inpatient claims paid
under the Inpatient Prospective Payment System.
- ALOS
- The Average Length of Stay is calculated as total patient days for the Base
MS-DRG
divided by its number of
discharges.
- Average
Charges - The Average Charge is calculated as total gross charges
for the Base MS-DRG
divided by its number of
discharges. Gross charges are amounts billed by the hospitals but
are not necessarily the amounts paid by Medicare or other payers.
- Average
Payment - The Average Payment is the amount paid to the hospital for the
Base MS-DRG.
This amount does not include any capital pass-thru amount or
organ acquisition amount. It includes payments by Medicare (i.e. base
MS-DRG
payment, outlier payment, disproportionate share adjustment (DSH), indirect
medical expense adjustments (IME), adjustments for certain transfers,
etc.) It also includes amounts paid by or on behalf of the patient
(e.g. deductibles or coinsurance) and amounts paid by third party
insurers. The average reported for a Base
MS-DRG
is the total payment divided by its number of discharges.
- Average
Cost - Costs are calculated for each patient on the basis of
ratios of costs to charges for routine services and
ancillary areas.
Click here for cost allocation methodology. The
average reported for a Base
MS-DRG
is total allocated cost divided by its number of discharges.