Files for FY 2020 Final Rule and Correction Notice

Title
Files for FY 2020 Final Rule and Correction Notice
Fiscal Year
2020
Type of File
Tables and Data Files
Description
See below
  1. FY 20 Impact File (Final Rule and Correction Notice) : This file contains data elements by provider that were used in calculating the FY 2020 rates and impacts for the FY 2020 final rule and correction notice.    
  2. AOR/BOR File (Final Rule and Correction Notice) : This zip file for the FY 2020 final rule and correction notice contains one excel spreadsheet with multiple tabs: final rule and correction notice tabs for the After Outliers Removed (AOR) v37 and final rule and correction notice tabs for the Before Outliers Removed (BOR) v37. There are also two tabs for v36 AOR and BOR. Additionally, there are 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 : 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 2018, using the V35 Grouper).
  4. FY 2020 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 2020 IPPS Final Rule are derived from the March 31, 2019 quarterly update of the FY 2017 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.
  7. FY 2020 Final Rule and Correction Notice 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 2020 Final Rule Wage Index PUFs; S3 Part II and Occ Mix Data
    • FY 2020 Final Rule Average Hourly Wage by Provider and CBSA Public Use File
    • FY 2020 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
    • FY 2020 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
    • FY 2020 Final Rule and Correction Notice AHW by Provider Area Listing
  8. Hospital Readmissions Reduction Program Supplemental Data File : This file contains the final FY 2020 payment adjustment factors CMS applies to discharges that occur on or after October 1, 2019. It also contains information on the number of discharges used to determine the ratio of conditions/procedures-specific payments to total base operating diagnosis-related (DRG) payments.   
  9. FY 2020 IPPS Medicare DSH Supplemental Data File (Final Rule and Correction Notice) : 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 2020 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 2020.
    • Tab 4: The final rule FY 2020 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 2020.
    • 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. FY 2021 New Technology Thresholds (Final Rule and Correction Notice) : 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 2021. Applicants should use the correction notice version for their applications.
  11. The following files can be found on the MS-DRG Classifications and Software webpage: Definition of Medicare Code Edits v37;
    • ICD-10 MS-DRG Definitions Manual Files v37 (text version);
    • ICD-10-CM/PCS MS-DRG v37 Definitions Manual Table of Contents - Full Titles - HTML Versions;
    • Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 37, ICD-10 Software
  12. Table 1A-1E (Final Rule and Correction Notice) : This excel spreadsheet contains the Final Rule and Correction Notice FY 2020 Operating and Capital National Standardized Amounts.
  13. FY 2020 Tables 2, 3 and 4 (Wage Index Tables) (Final Rule and Correction Notice) : Contains five tabs, three for the final rule and two for the correction notice. (It has been brought to our attention that there may be an error with some of the CBSA Three Year Average Hourly Wages in table 3. For MGCRB reclassifications, per the MGCRB rules, hospitals are to use the Three Year MGCRB Reclassification Data File on the CMS website.) 
    • Table 2- Case-Mix Index and Wage Index Table by CMS Certification Number (CCN);
    • Table 3- Wage Index Table by CBSA;　
    • Table 4 - List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act.
  14. Table 5 (Final Rule and Correction Notice) : Contains two tabs, one for the final rule and one for the correction notice, which contains the following: List of MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
  15. Tables 6A-6K and Tables 6P.1a-6P.1b : 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.1a-6P.1b (ICD-10-PCS Codes for MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1716-F TABLE 6P ICD-10-PCS Codes for MS-DRG Changes.xlsx” for complete description of all tables.
  16. Tables 7A and 7B (Final Rule and Correction Notice) : Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 36 and MS-DRGs, version 37. This file contains 3 tabs: Table 7A (final rule) Table 7B (final rule), and Table 7B correction notice).
  17. Tables 8A, 8B, and 8C : Tables 8A and 8B contain the FY 2020 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the FY 2020 LTCH statewide average cost-to-charge-ratios.
  18. Table 10: No longer a Table; see #10.
  19.  Table 15 : This table contains the final FY 2020 payment adjustment factors CMS applies to discharges occurring on or after October 1, 2019.
  20. Tables 16A and 16B (updated 10/21/19) : 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 2020 Hospital VBP payment adjustment factors will not be used to adjust hospital payments. This file includes the proxy adjustment factors published for the FY 2020 IPPS Final Rule (CMS-1716-F).
    • Table 16B: Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2020. These actual factors are based on the finalized baseline and performance period for FY 2020 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2020. 
  21. Table 18 (Final Rule and Correction Notice) : FY 2020 Medicare DSH Uncompensated Care Payment Factor 3.
  22. MAC Implementation File 1 - Certain FY 2020 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 October 7, 2019.) 
  23. MAC Implementation File 2 - Certain FY 2020 LTCH PPS factors, including High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors. (Note, this reflects the correction notice issued on October 7, 2019.) 
  24. MAC Implementation File 3 - A list of hospitals that will receive the statutory reduction to the annual payment update for FY 2020 under the Hospital Inpatient Quality Reporting (IQR) Program.
  25. MAC Implementation File 4 - LUGAR county list 
  26. MAC Implementation File 5 - Instructions to Fill Out the PSF for the Wage Index and Reclassification. (Note: On page 6 and 7 of this file, MACs will find new instructions for hospitals that are not listed on FY 2020 Table 2 and new hospitals. The instructions include a deadline of when MAC must email CMS a list of hospitals not listed on FY 2020 Table 2. See the file for complete details.)

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