What does CMG code stand for?
– Case Mix Group
Data Specifications. IRF Grouper – Case Mix Group (CMG)
What does CMG mean in medical billing?
A case mix group (CMG) is used in patient classification system to group together patients with similar characteristics. This provides a basis for describing the types of patients a hospital or other health care provider treats (its case mix).
What is rehab CMG?
In acute inpatient rehabilitation, case mix group (CMG) is an indication of the complexity of an individual patient and is determined by primary diagnosis, comorbidities, age, and functional assessment upon admission.
How is CMI calculated example?
For example, if Hospital A has an average cost per patient of $1,000 and a CMI of 0.80 for a given year, their adjusted cost per patient is $1,000 / 0.80 = $1,250. Likewise, if Hospital B has an average cost per patient of $1,500 and a CMI of 1.25, their adjusted cost per patient is $1,500 / 1.25 = $1,200.
What is an insurance case mix?
Casemix is a system that measures hospital performance, aiming to reward initiatives that increase efficiency in hospitals. It also serves as an information tool that allows policy makers to understand the nature and complexity of health care delivery.
How are IRF reimbursed?
Reimbursement Rates – IRF Payment for IRFs is on a per discharge basis, with rates based on such factors as patient-case mix, rehabilitation impairment categories and tiered case-mix groups. Rates may be adjusted based on the length of stay, geographic area and demographic group.
What is IRF PPS?
Historically, each rule or update notice issued under the annual Inpatient Rehabilitation Facility (IRF) prospective payment system (PPS) rulemaking cycle included a detailed reiteration of the various legislative provisions that have affected the IRF PPS over the years.
What is the formula for CMI?
Case mix index is calculated by adding up the relative Medicare Severity Diagnosis Related Group (MS-DRG) weight for each discharge, and dividing that by the total number of Medicare and Medicaid discharges in a given month and year.