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

Medicare case mix index definition

20/03/2021 Client: saad24vbs Deadline: 2 Day

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

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:

Online Assignment Help
Finance Homework Help
Solutions Store
Top Grade Essay
Top Essay Tutor
Assignment Hub
Writer Writer Name Offer Chat
Online Assignment Help

ONLINE

Online Assignment Help

Give me a chance, i will do this with my best efforts

$17 Chat With Writer
Finance Homework Help

ONLINE

Finance Homework Help

I will cover all the points which you have mentioned in your project details.

$16 Chat With Writer
Solutions Store

ONLINE

Solutions Store

Hello, I an ranked top 10 freelancers in academic and contents writing. I can write and updated your personal statement with great quality and free of plagiarism

$48 Chat With Writer
Top Grade Essay

ONLINE

Top Grade Essay

You can award me any time as I am ready to start your project curiously. Waiting for your positive response. Thank you!

$26 Chat With Writer
Top Essay Tutor

ONLINE

Top Essay Tutor

I am known as Unrivaled Quality, Written to Standard, providing Plagiarism-free woork, and Always on Time

$59 Chat With Writer
Assignment Hub

ONLINE

Assignment Hub

I have read your project details. I can do this within your deadline.

$65 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

Global Issues: Chapter 2 - Vcaa 2012 biology exam 2 - Non first order spectra in nmr - Games by steven johnson essay - Pressure transmitter calibration formula - Adapting early childhood curriculum 9th edition pdf - The time complexity of algorithms. - Driving force car club - Calculate floor load width - Texas instruments scientific calculator ti-30xb multiview - Trevor noah south african airport - 65 atheldene drive glen waverley - Balloon circumference vs temperature experiment - Shield of achilles analysis - Debating Platform (research) - Questions on International Trade - 4046.9/18 - Embraer 190 aircraft maintenance manual - I need 600 words research paper in symptomatic treatment in Chiropractic - Meeting story format - Evaluate Part of an Organizational Improvement Plan - Identify the environmental forces that shape global marketing efforts - 7week6 - Superdry questionnaire answers - Disc - Sleeve adornment crossword clue - Igcse biology end of chapter answers chapter 13 - According to the textbook, to keep him from exalting himself, god gave him a thorn in the flesh. - Central obesity correlates with an increased incidence of - How to determine the end behavior of a graph - Ocr m1 june 2014 - Tax return project solutions - Ol 342 milestone one - Raspberry pi music player with buttons - Light bulb input energy - Quiz - Memo - 401 servo alarm vrdy off - Cloud Computing - How to copy effects in sony vegas - 2 coments each one 150 words (CITATION AND REFERENCE) - River town peter hessler sparknotes - Blade runner roy quotes - What does a cognitive neuroscientist study inquizitive - Nucor case analysis - Cloud programming and software environments ppt - As the twig is bent so grows the tree - Financial accounting tools for business decision making edition - Allen ivey microskills - Revenue & sales corporation and software solutions - Operational excellence refers to companies that ________. - Libreoffice calc random number - Nurs 6630 - When is gene expression blocked in the lac operon system - 1.125 12 unf thread - Marriott international swot analysis 2019 - Marketing - Safe harbor provisions under hipaa - A manager checked production records and found - The crucible matching 1 answer key - The mouse and the motorcycle - Golden research thoughts journal - Boeing 737 take off procedures - Hiatal hernia with reflux esophagitis icd 10 - Sap pp training syllabus - Profissional Applied Project - The medical chart of a 68 year old man - Psychiatric Cases - Case - HD - There are five sales associates at mid motors ford - Nurse Internship Strategy - How to factorise cubics - Conflict of the song of roland - Jetblue competitive strategy - Email Revisions - PSY 104 - 5.2 - Pros and cons of arming probation officers - Mixing what with what improves creativity - Paparazzi customer loyalty cards - Case study on conveyor belt - Fundamentals of electric circuits answers - Article Critique - Legal costs negotiators salford - Vitrebond indirect pulp cap - Chicago musical character descriptions - Hp 1810 48g manual - Sociology - Work - Matthew 5 43 48 relevance to other worldviews - How many excess electrons are in a typical lightning bolt - An introduction to literary criticism richard dutton pdf - English is a crazy language - Thesis statement for vaccine research paper - Dis 7 - Panda adaptive defense 360 administrator password - Clinical data management overview - Nazeing primary school newsletter - Environmental science history timeline - Emanuel medical center crisis in the healthcare industry - Stoichiometry of a precipitation reaction lab