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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)