Health sciences and medicine Case Mix Index
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1. Case Mix Index exercise
Complete the following questions and calculations.
1. What is a Case Mix?
2. What is the purpose of case mix?
3. What are the 4 components of case mix index?
4. List 4 factors that influence case mix.
5. Calculate Total CMS Relative Weight
Formula: Multiply the CMS Relative Weight by the total number of cases (patients) in the DRG group
a. Scenario 1:A facility has 29 Medicare cases that areassigned to DRG 69 which has arelative weight of 1.0005. What is theTotal Relative Weight for the cases? (Show calculation)
b. Scenario 2:A facility has 15 Medicare cases that areassigned to DRG 117 which has arelative weight of 0.7789. What is theTotal Relative Weight for all of thecases? (Show calculation)
6. Calculate Medicare Payment
Formula: Multiply the reimbursement per case by the number of cases performed
a. Scenario 1:A facility has 22 Medicare cases whichare reimbursed at $6,175 per case.What is the total Medicarereimbursement for all of the cases? (Show calculation)
b. Scenario 2:A facility has 59 Medicare cases that areassigned to DRG 175 which has arelative weight of 0.9557.If the hospital PPS rate is $4,200, whatis the total reimbursement for all ofthe cases?
a. Step One: Calculate the reimbursementper case (Show calculation)
b. Step Two: Multiply by the number ofcases (Show calculation)
7. Calculating Case Mix Index
Formula: The total number of CMS Relative Weights divided by the total number of patients served.
a. Scenario 1:The top ten DRG surgical proceduresperformed by a facility have a totalCMS Relative Weight of 45.8775.If the total number of patients served is29, what is the Case-Mix Index forthe facility? (Show calculation)
b. Scenario 2:The top ten DRG medical proceduresperformed by a facility have a total CMS Relative Weight of 23.6651. If the number of patients served is 55,what is the Case-Mix Index for thefacility? (Show calculation)
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