# Health sciences and medicine Case Mix Index

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)

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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)