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

Cmi calculation

06/01/2021 Client: saad24vbs Deadline: 3 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.

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:

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

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

Similar Homework Questions

Week-11 discussion cpm - How is lymph returned to the blood - Juvenile delinquency court orientation video - Chevelle wheel fitment guide - Toll ipec coffs harbour address - Crazy eddie fraud case - 62.50 euros in pounds - Churchill hospital site map - Molar heat of combustion symbol - How to win dots and boxes 4x4 - Oral and nasal listener - Nursing teaching plan template - Social work role play scenarios - Perimeter intrusion detection systems cissp - Vision mission and strategy of coca cola - American genealogical biographical index agbi - Inferential comprehension iep goals - Sociology - Jk rowling harvard commencement speech 2008 - Bt margin loan interest rate - Healthcare Financial Management and Decision Making - Walmart is good for the economy by john semmens - 5 - mi familia audio listen to the description and indicate if the statements are cierto or falso. - What is an evacuee - Ib data booklet math hl - What is a hearth in fahrenheit 451 - A colored ion generally indicates a - Case Study Analysis - Writing about movies 3rd edition pdf - Human impact worksheet answers - Accessdata certifies examiner - How to cite sentinel city in apa format - 26-32 knightsbridge parade east sovereign islands floor plan - Aims and objectives ppt - Elegant decor company's management is trying to decide - Internal and external stakeholders in healthcare - Ap psychology personality test - Termination phase of nurse client relationship - 8 bits to bytes - Brunoli inc v town of bradford - It's time for principles based accounting ethics - Reply to this discussion- Sarah - Human resource exam - Frankenstein reading guide letters answers - Does sugar dissolve in methylated spirits - Who is responsible for kiowa's death - Cloud Computing Week 6 Assignment - Master test plan vs detailed test plan - Excel independent project 2 4 - Expository writing grade 4 - 700 words: Chapter 11 – Review the employment challenge in the digital era (as well as the entire chapter). - Nr 443 community health nursing - Knowledge work systems kws definition - In self-directed learning, trainers do not control or disseminate instruction. - Restricted cos points calculator - Four layer bandage system - Security Proposal - Public health 101 riegelman pdf - Mcfarlan's strategic grid - Sales mix in units formula - Tension force questions - Module 11 Written Assignment - Best Practice - Qld law group springwood - Sistema quick flip bottle tesco - Alkaline water ionizer comparison - Chemistry infographic for thallium - IOM Future of Nursing Report and Nursing - 10- to 12-slide presentation with speaker notes due october 7th 2020 - Current Events Articles (8 paragraphs total) PLEASE REVIEW INSTRUCTIONS - The external genitalia of the female are collectively called - Jen buys sesame bagels and plain bagels - Calculate the number of moles in 27.50 grams cacoëä - Double rail track circuit - Possessive pronouns practice worksheet - Testout 4.3 3 connect network devices - The main components of a robot - Pre tax allows deds - Assignment - 4 - Gcse pe heart diagram - Role of Data Mining - Assignment - English 122 english composition i - I am in a pickle with my course it ends on the 21 but I have a two week grace period I have 5 assignments left. How much would this cost to complete the assignments in this time period - Medicare cheat sheet skin lesions - Physical education philosophy example - Japanese art red stamp - Jim jefferies amsterdam egg - Alcoa fastening systems aerospace - W9 law - Annotated bibliography on childhood obesity - Catton grove primary school - Pre-Algerbra - Campbellsville university cpt rules - Is fetac level 5 recognised in australia - Stihl fs55r carb settings - Lines that don t intersect - BA Assignment - The allocation of a plant asset's cost to expense over its useful life is called ________. - Dublin gaa training programme - Explain why political risk may discourage international business - The crucial role of the nurse in ehr implementation