PAYMENT RATES INSTITUTIONAL PROVIDERS

AOR/BOR Tables

This diskette contains data used to develop the Diagnosis Related Group (DRG) relative weights. It contains mean, maximum, minimum, standard deviation, and co-efficient of variation statistics by DRG for length of stay and standardized charges. The BOR tables are "Before Outliers Removed" and the AOR is "After Outliers Removed". (Statistical outliers, not payment outliers.)

1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
2. The Final Rule is usually published in the Federal Register, by the first week of September.

DRGS Relative Weights (Formally: Table 5 - DRGS)

This file contains a listing of Diagnosis Related Group (DRG) narrative description, relative weight, geometric mean, length of stay, and day outlier trim points. This table is published in the Federal Register as part of the Prospective Payment System Notice of Proposed Rule Making and the Final Notice.

1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
2. The Final Rule is usually published in the Federal Register, by the first week of September.

CMS Medicare Case-Mix Index File

This file contains the Medicare case-mix index by provider number as published in each year's update of the Medicare Hospital Prospective Payment System (PPS). The case-mix index is a measure of the costliness of cases treated by a hospital relative to the cost of the national average of all Medicare hospital cases, using Diagnosis Related Group (DRG) weights as a measure of relative costliness of cases.

1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register, usually by the end of May.
2. The Final Rule is published in the Federal Register, usually by the first week of September.

CMS Wage Data

This file contains the hospital hours and salaries used to create the wage indices used in the Medicare Hospital Prospective Payment System (PPS).

1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register,usually in mid-February.
2. The Final Rule is published in the Federal Register usually in mid-May.

CMS Hospital Wage Indices (Formally: Urban/Rural/Hospital/Wage Indices)

This file contains a history of all wage indices used since October 1, 1983.

1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register usually in mid-February.
2. The Final Rule is published in the Federal Register usually in mid-May.

PPS Payment Impact File

This file contains data used to estimate FY 1999 payments under Medicare's Prospective Payment System (PPS) for capital costs. The data are taken from various sources, including the Provider Specific File, the PPS-X and PPS-XI Minimum Data Sets, and prior impact files. The data set is abstracted from an internal file used for the impact analysis of the changes to PPS published in the Federal Register. This file is available for release one month after the Final Rule is published in the Federal Register, usually during the first week of September.

PPS Standardizing File

This file contains information that standardizes the charges used to calculate relative weights to determine payments under PPS. Variables include wage index, Cost of Living Adjustment (COLA) case mix index, disproportionate share, and the Metropolitan Statistical Area (MSA). A new file is created for both the Notice of Proposed Rule Making (NPRM) and the Final Rule. The records are in provider number sequence, however, it is possible to have missing values in some records.

1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register, by the end of May.
2. The Final Rule is published in the Federal Register, usually by the first week of September.

Provider Specific File

This file is a component of the PRICER program used in the Fiscal Intermediary's (FI) system to compute individual hospital Diagnosis Related Group (DRG) payments. The file contains records for all Prospective Payment System (PPS) eligible hospitals, including hospitals in waiver states. Data elements used in the PPS recalibration processes and related PPS activities are also included.

1. 1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register, by the end of May.
2. The Final Rule is published in the Federal Register, usually by the first week of September.

Reclassified Hospitals

This file contains a listing of hospitals that were reclassified for the purpose of assigning a new wage index.

1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register, usually by the end of May.
2. The Final Rule is published in the Federal Register, usually by the first week of September.

SNF Prospective Payment Rates

This file contains cost, statistical, and other data used in establishing the Skilled Nursing Facility (SNF) prospective payment rates published in the Federal Register on May 14, 1998 for cost reporting periods beginning on or after July 1, 1998. The cost and statistical data are obtained from the hospital-based SNFs and Freestanding SNFs ( Forms 2552, 2540, and 2540S). This file also contains the standardization factors and case-mix correction factors.

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