Calculate estimated reimbursement for facilities and case mix

In the table below is the listing of Community Hospital's Top 10 MS-DRGs by Number of Discharges. Determine the MS-DRG weight, total weight and the estimated reimbursement to the facility for each DRG as well as the case mix for this group of MS-DRGs.

Community Hospital has a base rate of $5,750

Enter the weight of the MS-DRG - use the Table 5 information

Multiply the weight by the number of discharges - this gives you the total weight

Take the Base Rate for the hospital and multiply that by the weight - - this gives you the estimated revenue for that MS-DRG for an individual patient. - You compute this for the total group of patients.

Determine the estimated reimbursement for each MS-DRG.

Determine the case mix for this group of patients.

Community Hospital

Top 10 MS-DRGs by Discharge

MS-DRG

DRG Name

No. of Discharges

MS-DRG Weight

Total Weight

Total Estimated Reimbursement

73

Cranial & peripheral nerve disorders w MCC

230

114

Orbital procedures w/o CC/MCC

202

135

Sinus & mastoid procedures w CC/MCC

198

154

Other Ear, Nose, Mouth & Throat Diagnoses w MCC

145

163

Major chest procedures w MCC

120

186

Pleural effusion w MCC

103

194

Simple pneumonia & pleurisy w CC

96

207

Respiratory system diagnosis w ventilator support 96+ hours

83

228

Other cardiothoracic procedures w MCC

80

234

Coronary bypass w cardiac cath w/o MCC

78