Wiki National Average Medicare Reimbursement for DRG?

[richardson.amanda2@gmail.com]

I recently transitioned from a PB role to more of an HB focus, so I'm still getting up to speed. Is there a way for me to look up the CMS national average reimbursement for different DRGs?

 

[sls314]

I recently transitioned from a PB role to more of an HB focus, so I'm still getting up to speed. Is there a way for me to look up the CMS national average reimbursement for different DRGs?

You can look up the Medicare DRG rates for your specific facility. Medicare rate information is all readily available - the IPPS web pricer can be found here: https://www.cms.gov/ipps-webpricer

An individual patient's Medicare allowed amount might vary due to outlier or transfer status, but for most patients the facility reimbursement would typically be the DRG rate.

Edit to add: The underlying data files and components that are used to build the rate in the pricer can all be found on the CMS website as well: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps