Attachment_IV_-_Computation_of_Basic_MS-DRG_Payments.pdf

RFPP04021500003

Attachment IV

Computation of Basic MS-DRG Payments (i.e., Operating Federal Rate) Duluth, MN-WI

Core-Based Statistical Area 20260

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 geographical 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

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. 163, Friday, August 22, 2014 for discharges on/after October 1, 2014.

Table 1A, National Adjusted Operating Standardized Amount:

Labor-related: $3,784.75 Nonlabor-related: $ 1,653.10

Table 4A, Wage Index for CBSA (20260, Duluth, MN-WI): 1.0374

Table, Cost of Living Adjustment Factor: Not applicable

Table 5 MS-DRG Relative Weight (MS-DRG, Intracranial Vascular Procedures with PDX Hemorrhage w/CC): 7.1555

Application for MS-DRG 021

Step 1: $3,784.75

Step 2: $3,784.75 X 1.0374 = $3,926.30 Step 3: Not applicable Step 4: $3,926.30 + $ 1,653.10 = $5,579.40 Step 5: $5,579.40 X 7.1555 = $39,923.40

Payment for MS-DRG 021 under the contract would be $39,923.40 plus or minus any premium or discount established as the contract rate.