Attachment_1-DRG_Payment.pdf

Attachment 1

RFPP04101500001

Computation of Basic MS-DRG Payments (i.e., Operating Federal Rate) CBSA 52, for Rural areas in Wisconsin

Calculation of the Operating Federal Rate:

Step 1: Select the applicable average standardized amount for the full update

Step 2: Multiply the labor-related portion of the standardized amount by the applicable wage index for the geographic area

Step 3: For hospitals in Alaska and Hawaii, multiply the nonlabor-related portion of the standardized amount by the applicable cost-of-living adjustment factor -(N/A)

Step 4: Add the amount from Step 2 and the nonlabor-related portion of the standardized amount (adjusted, if applicable, under Step 3

Step 5: Multiply the final amount from Step 4 by the relative weight corresponding to the applicable

MS-DRG

Index Figures: Obtained from the Federal Register, Vol. 79, No. 192, Friday, October 3, 2014, for discharges on/after

October 1, 2014.

Table 1B, National Adjusted Operating Standardized Amount:

Labor-related: $3,371.47

Nonlabor-related: $2,066.38

Table 4B, Wage Index for Rural Areas by CBSA (Rural Area 52 –Wisconsin): .8995

Table, Cost of Living Adjustment Factor: Not applicable

Table 5, MS-DRG Relative Weight (MS-DRG 76, Viral Meningitis w/o CC/MCC): .8629

Application for MS-DRG 076 (example):

Step 1: $3,371.47

Step 2: $3,371.47 X .8995 = $3,032.64

Step 3: Not Applicable

Step 4: $3,032.64 + $2,066.38 = $5,099.02

Step 5: $5,099.02 X .8629 = $4,399.94

Payment for MS-DRG 076 under the contract would be $4,399.94, plus or minus any premium or discount established as the contract rate.