Questions and answers

What is the 60 percent rule?

What is the 60 percent rule?

The 60% Rule is a Medicare facility criterion that requires each IRF to discharge at least 60 percent of its patients with one of 13 qualifying conditions.

What is a Case Mix Group Code?

A case mix group (CMG) is used in patient classification system to group together patients with similar characteristics. Case mix groups are used as the basis for the Health Insurance Prospective Payment System (HIPPS) rate codes used by Medicare in its prospective payment systems.

What is a CMG in rehab?

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.

What is the IRF-Pai?

The IRF-PAI is the assessment instrument IRF providers use to collect patient assessment data for quality measure calculation and payment determination in accordance with the IRF Quality Reporting Program (QRP).

What is a Medicare CMG code?

The CMG is a 5-digit code, beginning with A, B, C, or D. It is located in the HIPPS/HCPCS field (FL 44 of the UB 04) on the claim, specifically on the Revenue Code 0024 line. Note that the IRF completes an assessment of the patient and this code comes from the PAI (patient assessment instrument) the provider uses.

What is the Medicare copay for rehab?

Medicare pays part of the cost for inpatient rehab services on a sliding time scale. After you meet your deductible, Medicare can pay 100% of the cost for your first 60 days of care, followed by a 30-day period in which you are charged a $341 co-payment for each day of treatment.

How many case mix groups are there currently?

“There are 115 DPG groups, each one defined by a set of intervention codes from CCI.

How do you code CMG?

What does CMG stand for CMS?

– Case Mix Group
IRF Grouper – Case Mix Group (CMG) | CMS. The .gov means it’s official.

How are case mix rates determined in PA?

Case-mix rates for all Medical Assistance (MA) nursing facilities’ were determined in accordance with the conditions and limitations specified in 55 PA. Code Chapter 1187 and the commonwealth’s Title XIX State Plan.

How is the case mix index of a hospital calculated?

This file contains hospitals case mix indexes (CMI) for discharges. A hospital’s CMI represents the average diagnosis-related group (DRG) relative weight for that hospital. It is calculated by summing the DRG weights for all Medicare discharges and dividing by the number of discharges.

Which is the most recent proposed case mix rate?

Proposed Rates — These are the most recent proposed case-mix rates. Condensed Final Rates — These are the condensed versions of final case-mix rates. These documents consist of Provider Names, MA CMI Averages, and Final Rates. Detailed Final Rates — These are full Excel spreadsheets for final case-mix rates.

What happens when you have more than one case mix in Minnesota?

In Minnesota, if a resident qualifies for more than one case mix classification, the classification with the highest index or weight is the one used for payment. This is referred to as index maximization.