Files for FY 2016 Final Rule and Correction Notice

All Excel files contain a text file for 508 compliance. Text files are 508 compliant by themselves.

1. FY 16 Impact File (Final Rule and Correction Notice): The impact file contains data elements by provider that were used in calculating the final FY 2016 rates and impacts. This file contains multiple tabs including the final rule impact file issued July 2015 and an updated impact file that corresponds to the correction notice (CMS-1632-CN2) issued October 2015.
2. AOR/BOR File: This zip file contains two excel spreadsheets, one for the After Outliers Removed (AOR) and one for the Before Outliers Removed (BOR). There are also two files containing the variable descriptions. The variables in these files are used in the calculations of the relative weights as well as other calculations for the inpatient PPS. All text files in the zip file are for 508 compliance.
3. Case Mix Index File: This file contains the non-transfer adjusted case mix index (CMI) based on the MS-DRGs billed on the claim in the year the claim was incurred (that is, during FY 2014, using the V31 Grouper).
4. FY 2016 Final Rule HCRIS Data File: CMS uses hospital cost report data from the Medicare Cost Report, Hospital Form 2552-10, to calculate the Cost-to-Charge Ratios (CCRs) used in the cost based MS-DRG relative weight methodology.  The database for the Medicare cost reports is the Healthcare Cost Report Information System (HCRIS).  The CCRs used in the calculation of the MS-DRG relative weights for the FY 2016 IPPS Final Rule are derived from the March 31, 2015 quarterly update of the FY 2013 HCRIS.  (HCRIS is updated on a quarterly basis).
5. Standardizing File: This file is used to standardize charges for the rate building process.
6. County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File: This file contains two tabs: A crosswalk of county codes to CBSAs and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files (formerly Table 4E).
7. FY 2016 Final Rule and Correction Notice Wage Index Public Use Files: Open Attached Zip file. Contains two zip files, one for final rule files and one with correction notice files. Each zip file contains a PDF with a description of each zip file.
8. FY 2016 IPPS Final Rule Hospital Readmissions Reduction Program Supplemental Data File:  This file contains the final FY 2016 payment adjustment factors under the Hospital Readmissions Reduction Program and the number of cases and excess readmissions ratios for the five conditions (heart failure, pneumonia and acute myocardial infarction, chronic obstructive pulmonary disease and total hip/total knee arthroplasty) used to calculate the final payment adjustment factors. In addition, it contains information on the number of cases for each of the applicable conditions excluded in the calculation of the readmission payment adjustment factors, and it contains DRG relative weight information to estimate the final payment adjustment factors.
9. FY 2016 IPPS Final Rule and Correction Notice Medicare DSH Supplemental Data File: This file contains the final rule and correction notice FY 2016 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. In addition, the file contains the data used for Medicare DSH estimates to support of the calculation of Factor 1. Lastly, the file contains a list of hospitals that have undergone a merger so that the data of the merging hospitals has been combined to calculate the Factor 3 for the surviving hospital for FY 2016. The Factor 3 is the proportion of the uncompensated care amount that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. For FY 2016, the Factor 3 is a hospital's share of Medicaid days and Medicare SSI days relative to all DSH hospitals Medicaid days and Medicare SSI days. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2016.
10. Definition of Medicare Code Edits v33:  Zip file contains two PDFs:
    • ICD-9-CM Definitions of Medicare Code Edits for analyses purposes only.
    • ICD-10 Definitions of Medicare Code Edits.
      These files contain a description of each coding edit with the corresponding code lists. The ICD-10 Definitions of Medicare Code Edits file contains all the edits and the code lists effective for FY 2016. These documents are 508 compliant
11. ICD-9 and ICD-10 MS-DRG Definitions Manual Files v33: Zip file contains the following files:
    • A PDF that contains the ICD-9 MS DRG Definitions Manual for analyses purposes only
    • A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.
    • A zip file with the comparison file that summarizes the changes from ICD-10 v32 to ICD-10 v33.
    • A zip file that contains Chapters 1 and 2 of the Definitions Manual, the Design, Development and Definitions of the MS-DRGs.
12. ICD-10-CM/PCS MS-DRG v33 Definitions Manual Table of Contents - Full Titles - HTML Versions: Click on the link in the "Related Links" section below to access the HTML Version of the Definitions Manual.
13. Monthly Summary of Charges for Charge Inflation Factor: Excel spreadsheet contains two tabs. One has monthly charges by provider from April 2013 through March 2014. One has monthly charges by provider from April 2014 through March 2015.
14. FY 2016 HAC Reduction Program Information
15. Table 1A-1E (Final Rule, Correction Notice and Consolidated Appropriations Act of 2016): This excel spreadsheet contains three tabs which contains the final rule, correction notice and Consolidated Appropriations Act FY 2016 Operating and Capital National and Puerto Rico Specific Standardized Amounts.
16. Tables 2 and 3 Final Rule and Correction Notice (Wage Index Tables):  Excel file with multiple tabs that contains the final rule and correction notice Table 2- Final Case-Mix Index and Wage Index Table by CCN and Table 3- Final Wage Index Table by CBSA. Note: Table 2 contains information by CCN and information from the following tables that have been provided in previous fiscal years:  Tables 2, 4J, 9A, and 9C. Table 3 contains information by CBSA and information from the following tables that have been provided in previous fiscal years:  Tables 3A, 3B, 4A, 4B, 4C, 4D, and 4F. See the data files page for the Constituent Counties for Acute Care Hospitals File (formerly table 4E).
17. Table 5 (Final Rule and Correction Notice): Excel file with two tabs that contains the final rule and correction notice List of final MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
18. Tables 6B-6M and Tables 6P.1a-6P.2a: Table 6B-New Procedure Codes; Table 6I- Complete Major CC List; Table 6J- Complete CC List; Table 6K- Complete List of CC Exclusions; Table 6L- Principal Diagnosis Is Its Own MCC List; Table 6M- Principal Diagnosis Is Its Own CC List; Table 6M.1- Additions to the Principal Diagnosis Is Its Own CC List;
    Tables 6P.1a-6P.2a (ICD-10-PCS Code Translations for MS-DRG Changes): See summary tab in excel spreadsheet and/or summary file in zip file called “CMS-1632-F TABLE 6P.1a-6P.2a.zip” for complete description of all tables
19. Tables 7A and 7B: Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 32 and MS-DRGs, version 33
20. Tables 8A, 8B, and 8C: Tables 8A and 8B contain the final FY 2016 IPPS operating and capital statewide average cost-to-charge-ratios as published in the Federal Register. Table 8C contains the final FY 2016 LTCH statewide average cost-to-charge-ratios as published in the Federal Register.
21. Table 10 (Final Rule, Correction Notice and Consolidated Appropriations Act of 2016): Excel file with three tabs that contains the final rule, correction notice and Consolidated Appropriations Act of 2016 cost thresholds by MS-DRG for the cost criteria for new technology add on payment applications for applications for FY 2017.
22. Table 14 (Final Rule and Correction Notice): Excel file with two tabs that contains the final rule and correction notice List of Hospitals with Fewer than 1,600 Medicare Discharges Based on the March 2015 Update of the FY 2014 MedPAR File and Potentially Eligible Hospitals’ FY 2016 Low-Volume Hospital Payment Adjustment. (Eligibility for the low-volume hospital payment adjustment is also dependent upon meeting the mileage criteria specified at § 412.101(b)(2)(ii) of the regulations.)
23. Table 15:  FY 2016 Readmissions Adjustment Factors under the Hospital Readmissions Reduction Program, which are based on excess readmission ratios from the performance period of July 1, 20011 to June 30, 2014.
24. Hospital Value-Based Purchasing (VBP) Program Tables 16A and 16B:
    • Table 16A: Contains updated proxy adjustment factors under the Hospital VBP Program that were calculated using historical baseline and performance periods. These proxies for the FY 2016 Hospital VBP payment adjustment factors will not be used to adjust hospital payments. This file includes the proxy adjustment factors published for the FY 2016 Final Rule (CMS-1632-F).
    • Table 16B: Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2016. These actual factors are based on the finalized baseline and performance period for FY 2016 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2016.
25. Table 18 (Final Rule and Correction Notice): Excel file with two tabs that contains the final rule and correction notice FY 2016 Medicare DSH Uncompensated Care Payment Factor 3 and Projected DSH Eligibility