Information in this section summarizes billing statistics that effect
DRG-based reimbursement and may signal unexpected rates of complications, short
stays, and other important measures. Information is organized by selectable
medical services on the basis of DRG assignments. Claims data are taken from
the Medicare Provider Analysis and Review (MedPAR) file which is updated
annually by CMS based on the federal fiscal year. The MedPAR file includes
billing data for 100% of all Medicare fee-for-service claims (IPPS claims) for
discharges during the twelve months ending September 30.
- Service Name
- Medical services are based on groupings of patient MS-DRGs. By clicking on
the name of a service you can see the MS-DRGs that make it up.
- The CMI is the average relative weight for all cases reported in a period.
MS-DRGs at lower severity levels have lower relative weights and MS-DRGs at
higher severity levels have higher relative weights. The CMI provides a measure
- CC/MCC Rate
- The CC/MCC Rate is a measure of the incidence of complications (CCs) and
major complications (MCCs) within a period. The numerator is the number of
patients with MS-DRGs defined by the presence of a CC or MCC. The denominator
is the total number of IPPS patients.
- MCC Rate
- The MCC Rate is a measure of the incidence of major complications (MCCs)
within a period. The numerator is the number of patients with MS-DRGs defined
by the presence of an MCC. The denominator is the total number of IPPS
- Outlier Percentage
- Medicare IPPS patients that incur extraordinarily high costs are called
'outliers' and are eligible for additional payment. The number of outliers is
reported as a percentage of total IPPS patients. An unexpectedly high
percentage could indicate a problem with clinical cost management, cost
- Short Stay Percentage
- Medicare IPPS patients with short stays may indicate premature discharges
or inappropriate admissions. The number of short stays is reported as a
percentage of total IPPS patients. Short stays are defined as patients who
were discharged alive with a length of stay of 2 days or less.
- Acute Care Transfer Percentage
- Hospitals may be penalized for inappropriate transfers to another
short-term acute care hospital (STACH or CAH). The Acute Care Transfer
Percentage reports the number of such transfers as a percentage of total IPPS