Blended rate

rmhosler1rmhosler1
in CDI Talk Archive
Thanks Katie you reminded me of a question I need to get answered. We are adding payors to our software and I need the DRG grouper version and blended rate. I think I have the DRG grouper versions figured out but if anyone wants to give info on this that would be great!

I also need the blended rate which I think is different for each hospital and payor group. I was talking to finance dept and not getting what I need. Is this the number that is present after everything is added and subtracted ie core measures, incentives, etc? My next step is
to call billing?

Thanks Mary Hosler MSN, RN
Mary.Hosler@mclaren.net 

Sent from my phone


Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Each facility has a ‘blended rate’ used as a basis for compensation:


    These field include the: Operating Federal Rate, Operating IME Factor, Operating DSH Factor, Capitol Federal Rate, Capitol Hospital Rate, Geographic Adjustment Factor, Operating Cost to Charge Ratio, Capitol Cost to Charge Ratio, MSA Wage Index and Large Urban Facility.


    The list of these ‘should be available from a contact in your Finance Department.


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

  • ssalinasssalinas
    edited April 2016
    Do you have a grouper that calculates expected reimbursement? Is it accurate? If you do, all the info Paul lists has been entered in a config file which allows the grouper to calculate your hospital specific rate. You can try dividing the exp reimbursement by the DRG specific weight which will give you the rate. This has to be with a standard payment case. CMS payments are based on this rate times the DRG weight.

    All the data items Paul mentioned are also available on the CMS website in the IPPS Final Rule Impact File. Every hospital is listed with specific values. However there is a very complicated formula that all these have to be plugged in to.

    Or just ask Finance what your hospital’s DRG rate is. Someone should be able to tell you since I am sure they know what you expect to get paid and action is taken when reimbursement does not match expected reimbursement.

    Hope this helps….


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    As Sharon says….IF the correct and valid rates are entered into a grouper, then you can see the payment as you code. Be sure to enter the correct discharge disposition as this can affect payment if the case is computed on a ‘Transfer Basis”.

    PE

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

Sign In or Register to comment.