Files for FY 2013 Final Rule and Correction Notice

Title
Files for FY 2013 Final Rule and Correction Notice
Fiscal Year
2013
Type of File
Tables and Data Files
Description
See Below
  1. Impact File: This file contains data elements by provider that were used in calculating the FY 2013 rates and impacts, and reflects corresponding corrections made through March 2013.
  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 2011, using the V28 Grouper).
  4. Standardizing File: This file is used to standardize charges for the rate building process.
  5. County to CBSA Crosswalk File: This file lists the CBSA, SSA county code and FIPS county code for all counties. Any changes to the CBSAs through March 2010 have been incorporated.
  6. Wage Index Public Use Files: Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 6 zip files.
    • FY 2013 Final Rule Wage Index PUFs
    • FY 2013 Final Rule Average Hourly Wage by Provider and CBSA Public Use File
    • FY 2013 Final Occupational Mix Adjusted and Unadjusted Average Hourly Wages by Provider
    • FY 2013 Final Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
    • FY 2013 Final Occupational Mix Factor by Provider PUF
    • FY 2013 Final Rule AHW by Provider Area Listing
  7. Hospital Readmissions Reduction Program Supplemental Data File: This file contains the FY 2013 payment adjustment factors under the Hospital Readmissions Reduction Program (including September 2012 and March 2013 corrections), and the number of cases and excess readmissions ratios for the three conditions (heart failure, pneumonia and acute myocardial infarction) used to calculate the payment adjustment factors.
  8. Definition of Medicare Code Edits: This file contains a description of each coding edit with corresponding ICD-9-CM code lists. There are two chapters in this file. The first chapter contains all the edits and the code lists for FY 2013. The second chapter summarizes, by edit, the changes in the edit code list from the last release of the MCE. This document is 508 compliant.
  9. Table 1A-1E: This excel spreadsheet contains the FY 2013 Operating and Capital National and Puerto Rico Specific Standardized Amounts.
  10. Wage Index Final Rule and Correction Notice Tables:
    • 1588- Final Rule Tables: 2, 3A, 3B, 4A, 4B, 4C, 4D, 4E, 4F, 4J, 9A, 9C;
    • 1588-Correction Notice Tables: 2-CN, 4A-CN, 4B-CN, 4C-CN, 4J-CN, 9A-CN, 9J-CN.
  11. Table 5: List of final MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
  12. Tables 6B and 6G-6K: Table 6B New Procedure Codes; Table 6G Additions to the CC Exclusions List; Table 6I Complete MCC list; Table 6I.1 Additions to the MCC list; Table 6I.2 Deletions to the MCC list; Table 6J Complete CC list; Table 6J.1 Additions to the CC list; Table 6K Complete list of CC exclusions for the MS-DRGs;
  13. Tables 7A and 7B: Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs version 29 and MS-DRGs version 30.
  14. Tables 8A, 8B, and 8C: Tables 8A and 8B contain the FY 2013 IPPS operating and capital statewide average cost-to-charge-ratios as published in the Federal Register. Tables 8C contains the FY 2013 LTCH statewide average cost-to-charge-ratios as published in the Federal Register.
  15. Table 10: Table 10 contains the cost thresholds by MS-DRG for the cost criteria for new technology add on payment applications for applications for FY 2014.
  16. Table 14: List of Hospitals with fewer than 1,600 Medicare discharges based on the March 2012 update of the FY 2011 MedPAR file and potentially eligible hospitals' FY 2013 Low-Volume Payment Adjustment under 42 CFR 412.101. Eligibility for the low-volume payment adjustment for FY 2013 is dependent upon meeting the mileage criteria specified at section 412.101(b)(2)(ii) of the regulations. This table was included with the notice CMS-1588-N published in the Federal Register on March 7, 2013, which announced the changes to the payment adjustment for low-volume hospitals provided for by the American Taxpayer Relief Act of 2012.
  17. Table 15: FY 2013 Readmission adjustment factors under the Hospital Readmissions Reduction Program. Readmission Adjustment factors are based on excess readmission ratios from the performance period of July 1, 2008 to June 30, 2011, as finalized in the FY 2012 IPPS/LTCH PPS Final Rule. This file includes the FY 2013 readmission adjustment factors established in the FY 2013 IPPS/LTCH PPS Final Rule (CMS-1588-F) and the subsequent corrections to those factors made in October 2012 (CMS-1588-CN2) and March 2013 (CMS-1588-CN4).
  18. Table 16 Proxy and Actual Adjustment Factors (updated March 2013):

    Excel Spreadsheet contains three tabs:

    Tab One: Contains the proxy FY 2013 adjustment factors under the Hospital Value-Based Purchasing (VBP) program. The proxy adjustment factors under the Hospital VBP Program for FY 2013 were included along with the publication of the FY 2013 IPPS/LTCH PPS final rule and were estimated based on a hypothetical, historical period of performance. These factors were used as a proxy adjustment in lieu of the actual FY 2013 Hospital VBP payment adjustment factor, which was not available at the time of the publication of the FY 2013 IPPS/LTCH PPS final rule.

    Tab Two: Contains the originally published actual FY 2013 value-based incentive payment adjustment factors under the Hospital Value-Based Purchasing (VBP) program. These actual factors are based on the finalized baseline and performance period for FY 2013 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2013.

    Tab Three: Contains the corrected actual FY 2013 value-based incentive payment adjustment factors under the Hospital Value-Based Purchasing (VBP) program. These actual factors are based on the finalized baseline and performance period for FY 2013 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2013. These factors correct certain formatting and display errors to some of the factors that appear in Tab Two.

Downloads