Attachment III.pdf

Attachment III Computation of Basic MS-DRG Payment (i.e., Operating Federal Rate)

CBSA 36084 - Oakland - Fremont - Hayward, CA

Urban Area Payment Formula

Labor-related portion of the National Adjusted Operating Standardized Amount (NAOSA)(Full Update)(Table 1a or 1b, Federal Register)

X Wage Index for the Area (Table 4A for Urban Areas, Federal Register )

= Wage adjusted labor related portion

+ Nonlabor-related portion of the NAOSA (Full Update)(Table 1a or 1b, Federal Register )

= Wage Adjusted Rate

X MS-DRG Relative Weight (Table 5, Federal Register )

= Basic MS-DRG Payment for CBSA 36084 - Oakland - Fremont - Hayward, CA

Index Figures

Obtained from the Federal Register, VOL 73, No. 161, Tuesday, August 19, 2008 and Federal Register, VOL 73, No. 193, Friday, October 3, 2008 for discharges on/after October 1, 2008.

National Adjusted Operating Standardized Amounts (NAOSA) - Table 1a (full update)

Labor-related portion: $3,574.50 Nonlabor-related portion: $1,553.91

Wage Index for Urban Areas by CBSA - (Table 4A)

Oakland - Fremont - Hayward, CA (36084): 1.563

MS-DRG Relative Weight (Table 5)

MS-DRG 75, Viral Meningitis w CC/MCC: 1.673

Application For MS-DRG 075 (example)

$3,574.50 (Labor-related portion of the NAOSA) X 1.563 (Wage Index for the Area) + $1,553.91 (Nonlabor-related portion of the NAOSA) = $7,140.85 (Wage Adjusted Rate) X 1.673 (MS-DRG Relative Weight) = $11,946.65 (Basic MS-DRG Payment for Oakland - Fremont - Hayward, CA Hospitals, MS-DRG 075)

Payment for MS-DRG 075 under the contract would be $11,946.65 plus or minus any premium or discount established as the contract rate.