Chapter 5

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Accounting

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Apr 3, 2024

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2. MS-DRG Calculations (Level 4—Analyzing) Associate-level Competency: IV.2. Describe components of revenue cycle management and clinical documentation improvement. Baccalaureate-level Competency: IV.2. Manage components of the revenue cycle . For this exercise, use the file titled AB202022_Ch05_Exercises.xlsx , tabs MS-DRG Calculation Example and MS-DRG Calculations. This assignment consists of 10 inpatient acute care admissions; five for Community Hospital and five for Memorial Hospital. Calculate the MS-DRG reimbursement rate for each admission. Notice the fully adjusted base rate, charges, and cost-to-charge ratio are different for each facility. Remember that the fully adjusted base rate already includes adjustments for IME, DSH, and wage index. Once you have completed the calculations, answer the following questions. Question Answer Which figure has the biggest impact in determining profit/loss for an admission; base rate or cost-to-charge ratio (CCR)? Why? The cost-to-charge ratio has the most significant impact in determining profit/loss for admission since it establishes the cost of the encounter, allowing the MS-DRG reimbursement to decide whether the admission was profitable. What is the definition of a CC/MCC? How does the presence of a CC/MCC code impact the reimbursement for an admission? CC = Complication or comorbidity MCC = Major Complication or comorbidity The presence of a MCC or CC often indicates a patient who needs more resources; hence, hospitals get reimbursed extra to care for these patients. Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases? Surgical cases have a higher relative weight since they are often more resource- intensive than medical cases. What can Memorial Hospital do to improve their profit? Memorial Hospital may increase its profits by increasing its CCR. They may do it by reducing their expenses while charging as much as feasible.
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