Hospital Inpatient DRG Calculation Worksheet

DRG Calculation Worksheet and instructions, and Outlier Adjustment Calculation for Per Diem Priced Claims

• DRG Payment Calculation Worksheet Basic and Final Price (HFSWEB010) (pdf)
• Instructions for Basic and Final Price Calculation (HFSWEB010i) (pdf)
• Transfer-Out Adjustment (HFSWEB011) (pdf)
• Instructions for Transfer-Out Adjustment (HFSWEB011i) (pdf)
• Length-of-Stay Outlier (HFSWEB012) (pdf)
• Instructions for Length-of-Stay Outlier (HFSWEB012i) (pdf)
• Cost Outlier for DRG-Reimbursed Hospitals (HFSWEB013) (pdf)
• Instructions for Completion of Cost Outlier (HFSWEB013i) (pdf)
• Table B Hospital DRG Reimbursement Factors (pdf)
• Outlier Adjustment Calculation for Per Diem Priced Claims (HFSWEB014) (pdf)