Healthcare Revenue Cycle

Healthcare Revenue Cycle

The case mix index (CMI) can be defined as the average relative weight of all cases treated at a given facility or by a given physician. The CMI will reflect the resource intensity or clinical severity of a specific group in relation to other groups in the classification system.

Facilities will use the CMI to compare their CMI to others statewide. It can also be utilized to identify “at-risk” MS-DRGs that are targeted by multiple payer investigators such as OIG, RAC auditors and so forth. It can also be used to track trends in patient mix (total cases, medical/surgical cases).

Review the attached PowerPoint Slides that demonstrate how to calculate CMI. The attached Worksheet has identified the top 10 MS-DRGs for UNOH Hospital located in Lima, Ohio that you will be determining CMI. Also attached is the FY 2016 Proposed Rule Tables that include the MS-DRG, its description, weights, as well as Geometric and Arithmetic mean lengths of stay. Fill the table out to its entirety.

Utilizing the attached resources:

· Determine the CMI for UNOH Hospital

· Explain how the CMI might raise or lower dependent on the number of discharges per MS-DRG

· Explain how the information collected in this table could be used to support the new addition of a floor devoted to rehabilitation of joint replacement patients

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