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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)

Hospital Inpatient DRG Calculation Worksheet

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Hospital Inpatient DRG Calculation Worksheet

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