Files for FY 2019 Final Rule and Correction Notice

Title
Files for FY 2019 Final Rule and Correction Notice
Fiscal Year
2019
Type of File
Tables and Data Files
Description
See below
  1. FY 19 Impact File (Final Rule and Correction Notice) (ZIP) : This file contains data elements by provider that were used in calculating the FY 2019 rates and impacts for the FY 2019 final rule and correction notice. Note: The impact file is used to model payments and estimate impacts for the FY 2019 final rule and uses the best available data at the time of the final rule. It should NOT be relied upon for actual payment in FY 2019.
  2. AOR/BOR File (ZIP) : This zip file for the FY 2019 final rule contains one excel spreadsheet with multiple tabs: one for the After Outliers Removed (AOR) and one for the Before Outliers Removed (BOR). There are also two tabs 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 (ZIP) : 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 2017, using the V34Grouper).
  4. FY 2019 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 2019 IPPS Final Rule are derived from the March 31, 2018 quarterly update of the FY 2016 HCRIS. (HCRIS is updated on a quarterly basis).
  5. Standardizing File (ZIP) : 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 (ZIP) : 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.
  7. FY 2019 Wage Index Public Use Files (Final Rule and Correction Notice) (ZIP) : The Attached zip file contains 2 zip files, one for the FY 2019 Final Rule and one for the one for the FY 2019 Correction Notice. Each zip file contains a PDF with a description of each zip file. Each zip file contains 6 zip files:
    • FY 2019 Wage Index PUFs; S3 Part II and Occ Mix Data
    • FY 2019 Average Hourly Wage by Provider and CBSA Public Use File
    • FY 2019 Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
    • FY 2019 Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
    • FY 2019 AHW by Provider Area Listing
  8. FY 2019 IPPS Final Rule: Hospital Readmissions Reduction Program Supplemental Data File (ZIP) : This file contains the final FY 2019 readmissions payment adjustment factors under the Hospital Readmissions Reduction Program that will be applicable to discharges occurring on or after October 1, 2018. It also contains information on the number of cases for each of the applicable conditions and the base operating DRG payments used in the calculation of the readmission payment adjustment factors.
  9. FY 2019 IPPS Medicare DSH Supplemental Data File (Final Rule and Correction Notice) (ZIP) : This spreadsheet has 6 tabs (text files for each tab are included for Section 508 compliance): 
    • Tab 1: File Layout for the spreadsheet.
    • Tab 2: The correction notice FY 2019 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments.
    • Tab 3: The list of hospitals used in the correction notice that have undergone a merger so that the data of the merged hospitals have been combined to calculate the surviving hospital’s Factor 3 for FY 2019.
    • Tab 4: The final rule FY 2019 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments.
    • Tab 5: The list of hospitals used for the final rule that have undergone a merger so that the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2019.
    • Tab 6: The data used for Medicare DSH estimates to support the calculation of the Factor 1. The Factor 3 in the second tab is the amount available for uncompensated care payments that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. DSH hospitals are identified as those hospitals that are projected to receive DSH payments for FY 2019.
  10. Monthly Summary of Charges for Charge Inflation Factor (ZIP) : Excel spreadsheet contains two tabs. One has monthly charges by provider from April 2016 through March 2017. One has monthly charges by provider from April 2017 through March 2018.
  11. FY 2020 New Technology Thresholds (Final Rule and Correction Notice) (ZIP) : Contains the final rule and correction notice cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2020. Applicants should use the correction notice version for their applications.
  12. The following files can be found on the MS-DRG Classifications and Software webpage:
    • Definition of Medicare Code Edits v36
    • ICD-10 MS-DRG Definitions Manual Files v36 (text version)
    • ICD-10-CM/PCS MS-DRG v36 Definitions Manual Table of Contents - Full Titles - HTML Versions
    • Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 36, ICD-10 Software
  13. Table 1A-1E (Final Rule and Correction Notice): This excel spreadsheet contains the Final Rule and Correction Notice FY 2019 Operating and Capital National Standardized Amounts.
  14. FY 2019 Tables 2, 3 and 4 (Wage Index Tables) (Final Rule and Correction Notice): Contains six tabs, three for the final rule and three for the correction notice. 
    • Table 2- Case-Mix Index and Wage Index Table by CMS Certification Number (CCN);
    • Table 3- Wage Index Table by CBSA;
    • Table 4 New for FY 2019)- List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act.
  15. Table 5: List of MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
  16. Tables 6A-6K and Tables 6P.1c-6P.1f : Table 6A-New Diagnosis Codes; Table 6B-New Procedure Codes; Table 6C-Invalid Diagnosis Codes; Table 6D-Invalid Procedure Codes; Table 6E-Revised Diagnosis Code Titles; Table 6F-Revised Procedure Code Titles; Table 6G.1- Secondary Diagnosis Order Additions to the CC Exclusions List; Table 6G.2- Principal Diagnosis Order Additions to the CC Exclusions List; Table 6H.1- Secondary Diagnosis Order Deletions to the CC Exclusions List; Table 6H.2- Principal Diagnosis Order Deletions 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 6J.2- Deletions to the CC List; Table 6K.--Complete List of CC Exclusions; Tables 6P.1c-6P.1f (ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1694-F TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes.xlsx” for complete description of all tables.
  17. Tables 7A and 7B: Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 35 and MS-DRGs, version 36
  18. Tables 8A, 8B, and 8C: Tables 8A and 8B contain the FY 2019 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the FY 2019 LTCH statewide average cost-to-charge-ratios.
  19. Table 10: No longer a Table; see #11.
  20. Table 15: FY 2019 readmissions payment adjustment factors that will be applicable to discharges occurring on or after October 1, 2018.
  21. Table 16A: 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 2019 Hospital VBP payment adjustment factors will not be used to adjust hospital payments. This file includes the proxy adjustment factors published for the FY 2019 IPPS Final Rule (CMS-1694-F).
    • Table 16B: Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2019. These actual factors are based on the finalized baseline and performance period for FY 2019 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2019.
  22. Table 18 (Final Rule and Correction Notice): FY 2019 Medicare DSH Uncompensated Care Payment Factor 3.
  23. MAC Implementation File 1- Certain FY 2019 IPPS factors, including applicable percentage increase, budget neutrality factors, High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors. (Note, this reflects the correction notice issued on September 28, 2018.)  
  24. MAC Implementation File 2- Certain FY 2019 LTCH PPS factors, including High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors. (Note, this reflects the correction notice issued on September 28, 2018.)  
  25. MAC Implementation File 3- A list of hospitals that will receive the statutory reduction to the annual payment update for FY 2019 under the Hospital Inpatient Quality Reporting (IQR) Program.
  26. MAC Implementation File 4- LUGAR county list.
  27. MAC Implementation File 5- Instructions to Fill Out the PSF for the Wage Index and Reclassifications.

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