CMS Relative Weight Worksheet

 CMS Relative Weight Worksheet

Instructions/Descriptions

HI 215 CMS Relative Weight Worksheet for Global Unit 6

Assignment Worksheet for Unit 6 Case Mix Index (Use this document as your worksheet)

Case Mix is a term used to describe a group of people who

A patient population’s case mix is a description of that population-based on any number of the qualities listed below:

• Age
• Gender
• Insurance Types
• Diagnosis
• Danger Factors
• Treatments that were given
• Resources that were used

Purposes of Case Mixing

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• Case-mix techniques are employed for a variety of purposes, with reimbursement being the most popular.
• Relative weights and base payments for MS DRGs are determined using the case-mix approach.
• Case-mix approach can be used to describe or identify a specific patient population for statistical purposes.
• Because surgical cases need more resources than medical cases, the case-mix approach can be utilized to uncover differences in coding practice patterns and the complexity of the coding.

Case Mix Index (CMI) is a metric that measures how

• Disease Conditions and/or Procedures Classification
• Analyzes resource usage patterns.
• It’s used to figure out how much money you’ll get.
• Evaluation of other facilities
• The case mix index is the average of all cases treated at a given facility’s relative weights.
• The average CMI is 1.000 in theory. Cases with a CMI of over 1.000 are more complex, whereas those with a CMI of less than 1.000 are less complex.
• The CMI of surgical cases is higher than that of medical cases.

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The case mix index of a facility is influenced by a number of factors, including:

• Modifications to relative weight values
• Changes in the facility’s type of services offered or provided
• Documentation and coding accuracy.
• DRG assignment precision

Formulas for Case Mixtures

• To find the entire CMS relative weight, multiply the “CMS Relative Weight” by the total number of cases (patients) in the MS DRG category.
• To calculate the Case Mix Index, add all of the CMS Relative Weights together and divide by the total number of patients.

Total CMS Relative Weight Calculation

Multiply the “CMS Relative Weight” by the total number of cases (patients) in the DRG group to arrive at a formula.

• The first question
• A facility has 29 Medicare cases with a relative weight of 1.0005 that are allocated to DRG 69.
• What is the cases’ total relative weight?
• Second question
• A facility has 15 Medicare cases with a relative weight of 0.7789 that are allocated to DRG 117.
• For all of the situations, what is the Total Relative Weight?

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Case Mix Index Calculation

The number of CMS Relative Weights divided by the total number of patients serviced is the formula.

• The first question
• A facility’s top 10 DRG surgical operations have a total CMS Relative Weight of 245.8775.
• What is the Case-Mix Index for the institution if the total number of patients served is 129?
• Second question
• A facility’s top ten DRG medical procedures have a total CMS Relative Weight of 123.6651.
• What is the Case-Mix Index for the institution if the total number of patients served is 155?

Upload the completed worksheet to the Dropbox for the unit.

 CMS Relative Weight Worksheet

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