Loading...

Messages

Proposals

Stuck in your homework and missing deadline? Get urgent help in $10/Page with 24 hours deadline

Get Urgent Writing Help In Your Essays, Assignments, Homeworks, Dissertation, Thesis Or Coursework & Achieve A+ Grades.

Privacy Guaranteed - 100% Plagiarism Free Writing - Free Turnitin Report - Professional And Experienced Writers - 24/7 Online Support

Case mix index formula

05/01/2021 Client: saad24vbs Deadline: 14 Days

Case Mix Management


CMI usage and calculations


By: Deborah Balentine M.Ed, RHIA, CCS-P


*


What is a Case-Mix?


Age

Gender

Type of Insurance

Diagnosis

Risk Factors

Treatments received

Resources used

*


The case mix of a patient population is a description of that population based on any number of the following characteristics:


Purposes


To determine reimbursement.

DRGs

APCS

MPFS

To describe a population being served.

To identify differences in practice patterns or coding complexity.

*


Case-mix methodologies are used for a number of purposes with the most common usage being for reimbursement. Case-mix methodology is used to determine relative weights and base payments for DRGs and APCs. Case-mix methodology is used with the MPFS when calculating the Geographic Practice Cost Index (GCPI).


Case-mix methodology can be used for statistical purposes to describe or identify a particular patient population.


Case-mix methodology can also be used to identify differences in coding practice patterns and the complexity of the coding because surgical cases are generally more resource extensive than medical cases.


Severity of Illness Classifications


Extent of the disease

Risk of mortality

Need for intervention

Urgency of care

Intensity of resources

Difficulty of treatment

*


The most common case mix methodology is to group cases by diagnoses and procedures. The major criticism to this type of grouping is that the diagnoses and procedures do not accurately measure the severity of an illness. The APR-DRG case-mix methodology was developed to address those concerns.


Severity of Illness Classfications


Adjusted Clinical Groups

National Association of Children’s Hospital and Related Institutions (NACHRI)

Medical Outcomes Study Short Form Health Survey

Atlas System

*


Severity of Illness Classifications includes the following:


Adjusted Clinical Groups - classifies individuals into groups that are likely to have similar resource requirements.


National Association of Children’s Hospitals and Related Institutions (NACHRI) - classifies diseases based on the progression of the disease, the anticipated course of the disease, and treatment goals.


Medical Outcomes Study Short Form Health Survey - classifies by severity of the disease and health status measures. Also uses patient feedback to obtain a total picture of the disease process.


Atlas System - uses information abstracted from the medical record from all points of care including ancillary service data excluding diagnosis data.


Diagnostic/Procedural/Severity Classifications


Resource Utilization Groups (RUGs)

Functional Related Group System (IRFPPS)

Home Health Resource Grouping System (HHPPS)

*


Some case mix classifications use a combination of diagnoses and procedures and severity of illness in their methodology. These systems are:


Resource Utilization Groups - used in the skilled nursing facility prospective payment system (SNFPPS). Includes clinical factors such as cognition, sensory deficits and psychological well-being


Functional Related Group System - used in the inpatient rehabilitation prospective payment system (IRFPPS). Includes clinical factors such as activities of daily living (ADLs) and spinal cord injury data.


Home Health Resource Grouping System - used in the home health prospective payment system (HHPPS). Includes measuring the extent of pain, respiratory status, and integrity of the Integumentary system. Also uses social factors such as residential and caregiver demographics.


Risk Adjustment


Age and gender adjustments

Clinical risk adjustments

Situation-specific adjustments

Adjustments for specific clinical conditions

Adjustments by specialty type

*


Any method used to compare the severity of illness in one group of patients in comparison to the severity of illness in another group of patients. Used make a fair comparison of diverse populations and treatment patterns. Types of risk adjustments include:


Case-Mix Index


Classification by Disease Conditions and/or Procedures

Determines patterns of resource use

Used to determine anticipated reimbursement.

Comparison to other facilities

*


The most commonly used case mix index uses disease staging as the basis for classifying patient with similar conditions to determine patterns of resource use. This type of case mix is also used by a facility to determine anticipated reimbursement and to compare the results to other facilities.


The case mix index is the average of the relative weights of all cases treated at a given facility. The theoretical average CMI is 1.000. CMI’s over 1.000 signify more complex cases and CMI’s less than 1.000 signify less complex cases. Surgical cases have a higher CMI than medical cases.


Factors that influence Case-Mix


Changes in Relative Weights

Changes in Services

Accuracy in Documentation and Coding

Accuracy in DRG/APC assignment

*


Factors that influence a facility’s case mix index include:


Changes made in relative weight values


Changes in the type of services offered or provided by the facility


Accuracy of documentation and coding in DRG or APC assignment


Calculating Case-Mix Indexes


Calculating Total CMS Relative Weight

Calculating Case Mix Index

Calculating Medicare Payment

Determining the Highest Relative Weight

*


Case Mix Analysis begins with the calculation of the Case Mix Index. The Case-Mix Index is the average of the relative weights of all cases treated at a given facility or by a given physician. The Case Mix index average is set at 1.0000.


Calculating Case-Mix Index


Services to be measured

Relative Weight

# of Cases

*


When calculating the Case Mix Index for a group of procedures, you will need the following information:


Services to be measured – Most facilities calculate their case-mix index by using the most resource extensive procedures or by the reason for the admission (PDx).


Relative Weights are determined by Medicare or other third-party payers


# of Cases or Patients served for a particular service or procedure.


Case Mix Formulas


Calculating Total CMS Relative Weights

Calculating Medicare/Third-Party Payment

Calculating Case-Mix Index

Determining the Highest Relative Weight for a group of cases

*


Calculating Total CMS Relative Weight – Multiply the “CMS Relative Weight” by the total number of cases (patients) in the DRG group.


Calculating Medicare Payment – Multiply the reimbursement per case by the number of cases performed


Calculating Case Mix Index - Add up the total number of CMS Relative Weights and divide by the total number of patients.


Determining the Highest Relative Weight – The highest relative weight is the DRG with the highest total relative weight.


Calculating Total CMS Relative Weight


Multiply the “CMS Relative Weight” by the total number of cases (patients) in the DRG group


*


Example One


A facility has 29 Medicare cases that are assigned to DRG 69 which has a relative weight of 1.0005. What is the Total Relative Weight for the cases?


*


Answer


29.0145


1.0005 x 29


*


Example Two


A facility has 15 Medicare cases that are assigned to DRG 117 which has a relative weight of 0.7789. What is the Total Relative Weight for all of the cases?


*


Answer


11.6835


0.7789 x 15


*


Calculating Medicare Payment


Multiply the reimbursement per case by the number of cases performed


*


Example Three


A facility has 22 Medicare cases which are reimbursed at $6,175 per case.


What is the total Medicare


reimbursement for all of the cases?


*


Answer


$135,850.00


$6,175 x 22


*


Example Four


A facility has 59 Medicare cases that are assigned to DRG 175 which has a relative weight of 0.9557.


If the hospital PPS rate is $4,200, what is the total reimbursement for all of the cases?


*


This calculation sometimes requires a second step in which you must determine the DRG payment first


Answer


$236,822.46


Step One: Calculate the reimbursement per case


0.9557 x $4,200 (PPS rate) = $4,013.94


Step Two: Multiply by the number of cases


$4,013.94 x 59 = $236,822.46


*


Calculating Case Mix Index


The total number of CMS Relative Weights divided by the total number of patients served.


*


Example Five


The top ten DRG surgical procedures performed by a facility have a total CMS Relative Weight of 45.8775.


If the total number of patients served is 29, what is the Case-Mix Index for the facility?


*


Answer


1.5819


44.8775 / 29 = 1.5819


*


Example Six


The top ten DRG medical procedures performed by a facility have a total CMS Relative Weight of 23.6651


If the number of patients served is 55, what is the Case-Mix Index for the facility?


*


Answer


0.4302


23.6651 / 55 = 0.43027 or 0.43028


*


Surgical DRG Cases have higher CMI’s than DRG medical cases.


Recap


The case mix of a patient population is a description of that population based on any number of characteristics.

Case-Mix indexes are used to describe a population that is being served, to determine reimbursement, and to identify differences in practice patterns or coding complexity.

The most commonly used Case-Mix Index uses disease conditions and/or procedures to determine resource use.

*


Recap (cont.)


Severity of Illness case-mix methodologies were developed to address concerns that traditional case-mix methodologies do not capture the severity of an illness.

Risk Adjustment is any method used to compare the severity of illness in one group of patients in comparison to the severity of illness in another group of patients. Used make a fair comparison of diverse populations and treatment patterns

*


*


*


The case mix of a patient population is a description of that population based on any number of the following characteristics:


*


Case-mix methodologies are used for a number of purposes with the most common usage being for reimbursement. Case-mix methodology is used to determine relative weights and base payments for DRGs and APCs. Case-mix methodology is used with the MPFS when calculating the Geographic Practice Cost Index (GCPI).


Case-mix methodology can be used for statistical purposes to describe or identify a particular patient population.


Case-mix methodology can also be used to identify differences in coding practice patterns and the complexity of the coding because surgical cases are generally more resource extensive than medical cases.


*


The most common case mix methodology is to group cases by diagnoses and procedures. The major criticism to this type of grouping is that the diagnoses and procedures do not accurately measure the severity of an illness. The APR-DRG case-mix methodology was developed to address those concerns.


*


Severity of Illness Classifications includes the following:


Adjusted Clinical Groups - classifies individuals into groups that are likely to have similar resource requirements.


National Association of Children’s Hospitals and Related Institutions (NACHRI) - classifies diseases based on the progression of the disease, the anticipated course of the disease, and treatment goals.


Medical Outcomes Study Short Form Health Survey - classifies by severity of the disease and health status measures. Also uses patient feedback to obtain a total picture of the disease process.


Atlas System - uses information abstracted from the medical record from all points of care including ancillary service data excluding diagnosis data.


*


Some case mix classifications use a combination of diagnoses and procedures and severity of illness in their methodology. These systems are:


Resource Utilization Groups - used in the skilled nursing facility prospective payment system (SNFPPS). Includes clinical factors such as cognition, sensory deficits and psychological well-being


Functional Related Group System - used in the inpatient rehabilitation prospective payment system (IRFPPS). Includes clinical factors such as activities of daily living (ADLs) and spinal cord injury data.


Home Health Resource Grouping System - used in the home health prospective payment system (HHPPS). Includes measuring the extent of pain, respiratory status, and integrity of the Integumentary system. Also uses social factors such as residential and caregiver demographics.


*


Any method used to compare the severity of illness in one group of patients in comparison to the severity of illness in another group of patients. Used make a fair comparison of diverse populations and treatment patterns. Types of risk adjustments include:


*


The most commonly used case mix index uses disease staging as the basis for classifying patient with similar conditions to determine patterns of resource use. This type of case mix is also used by a facility to determine anticipated reimbursement and to compare the results to other facilities.


The case mix index is the average of the relative weights of all cases treated at a given facility. The theoretical average CMI is 1.000. CMI’s over 1.000 signify more complex cases and CMI’s less than 1.000 signify less complex cases. Surgical cases have a higher CMI than medical cases.

Homework is Completed By:

Writer Writer Name Amount Client Comments & Rating
Instant Homework Helper

ONLINE

Instant Homework Helper

$36

She helped me in last minute in a very reasonable price. She is a lifesaver, I got A+ grade in my homework, I will surely hire her again for my next assignments, Thumbs Up!

Order & Get This Solution Within 3 Hours in $25/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 3 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 6 Hours in $20/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 6 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 12 Hours in $15/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 12 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

6 writers have sent their proposals to do this homework:

Top Essay Tutor
University Coursework Help
Helping Hand
Writer Writer Name Offer Chat
Top Essay Tutor

ONLINE

Top Essay Tutor

I have more than 12 years of experience in managing online classes, exams, and quizzes on different websites like; Connect, McGraw-Hill, and Blackboard. I always provide a guarantee to my clients for their grades.

$65 Chat With Writer
University Coursework Help

ONLINE

University Coursework Help

Hi dear, I am ready to do your homework in a reasonable price.

$62 Chat With Writer
Helping Hand

ONLINE

Helping Hand

I am an Academic writer with 10 years of experience. As an Academic writer, my aim is to generate unique content without Plagiarism as per the client’s requirements.

$60 Chat With Writer

Let our expert academic writers to help you in achieving a+ grades in your homework, assignment, quiz or exam.

Similar Homework Questions

Iupac name of alkane alkene alkyne - Business - Can a playground be too safe - Market myopia definition - Pronated grip cable fly - Super star clay targets - Change management in healthcare literature review - Words that end in tion - Human Services - Comparing and contrasting transition words - Salesforce integration architecture designer dumps - Web site report - Ritz furniture has a contribution margin - Johnny jolter power plunger lowes - Managing in the global marketplace - Cash flow forecast definition tutor2u - Genesis 15 1 6 niv - Rain dial plus 12 manual - Coca cola amatil vending machine overcharge - Tlmt 601 - Human capital measurement ppt - 1800 in 24 hour time - Dr alan doube rheumatologist - Numerical coefficient and literal coefficient examples - AUTHORIESED HEALTH +27835179056 Capitalized Safe abortion clinic//pills in Umdloti Umgababa Umhlanga Rocks Umlazi Verulam limpopo - Hag seed revenge quotes - Finance - Which way does the wind usually blow - Descriptive essay - Pain neutralization technique dvds for sale - Job postings are effective internal recruitment tools because they - My personal culture essays - Art yasmina reza monologue - Communication and cooperation skills - 01.10 macbeth: the power of words worksheet - University of salford staff channel - Reserve based lending primer - Mathswatch answers forming formulae and equations - Ielts verification candidate identity - Muslim Molvi 7340613399 OnLine No 1 FaMOUs VashIKaraN sPecIaLIsT IN Berhampur - How to write an alphanumeric outline - Conduire conjugation present tense - Apple's sTRATEGY - Chemistry matter and change chapter 9 study guide answers - Po box 960 archerfield qld 4108 - Co 3+ electron configuration - Wrd 204: writing exercise 5 - Michael douglas wall street quotes - Prp sw file name - The 2018 human resources trends to keep on your radar - PSY 5107 Week 4 – Assignment: Customize Potential Research Questions and Hypotheses - Gcu mission and general education competencies - Miles away from the earth is the moon - Emerging issues in information systems audit - Infotech import in strtagic plan - IT Infrastructure Policies - Delta airlines case analysis - Down girl the logic of misogyny review - Safaricom organizational chart - Comida española tacos al aguacate tortilla como tostada - Bumpy rollouts of erp systems are usually caused by - Red hill greek church easter - Titanic case study ethics - Cyber Security - Civilize them with a stick - How to write a conclusion for a newspaper article - El gran hotel episode summaries - Nanda nursing diagnosis list 2020 - Examine individualism versus engaged citizenship - Accented neutral interior design - The emt should assess for hypoglycemia in small - Dulux natural white exterior - Small town mentality in to kill a mockingbird - Lafreniere park a boo halloween festival october 26 - Health Care Delivery Models and Nursing Practice - Alo, soy ana. ¿que tal? - Slope stained glass project - Multicultural Considerations - Sociology - What is a whs duty holder - Muslim Molvi 7340613399 OnLine No 1 FaMOUs VashIKaraN sPecIaLIsT IN Muzaffarpur - Limiting reagent lab baking soda vinegar answers - Discussion - Countries with autocracy based governments have - A series rlc circuit has a 130 khz resonance frequency - In the context of dollar-value lifo, what is a lifo layer? - Karl blossfeldt artist research - The penelopiad and photograph 51 - Stepping Stones to the Civil War - The sound of music assignment - Heat enthalpy of reaction and calorimetry lab report - Biblical basis for small groups - The numerical value of the standard deviation can never be - Task - Urgent 1- 7 hours due - Verbal contingencies lidcombe program - 4-6 page research paper on a myth - Examples of persuasive devices - Exception when others then - Rhetorical Analysis