- FY 2016 Final Rule and Correction Notice Data Files
- Type of File
- Impact File and Data Files
Below are the data files and impact file for the FY 2016 final Rule and correction notice. The tables for the FY 2016 final rule and correction notice are located on a separate list.
All Excel files contain a text file for 508 compliance. Text files are 508 compliant by themselves.
- 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.
- 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.
- 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).
- 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).
- Standardizing File: This file is used to standardize charges for the rate building process.
- 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).
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- FY 2016 HAC Reduction Program Information
- FY 16 Impact File (Final Rule and Correction Notice) [ZIP, 3MB]
- AOR/BOR File [ZIP, 1MB]
- Case Mix Index [ZIP, 45KB]
- FY 2016 Final Rule: HCRIS Data File [ZIP, 25MB]
- Standardizing File [ZIP, 533KB]
- County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File [ZIP, 237KB]
- FY 2016 Final Rule and Correction Notice Wage Index Public Use Files [ZIP, 6MB]
- FY 2016 IPPS Hospital Readmissions Reduction Program Supplemental Data File (Final Rule and Correction Notice) [ZIP, 4MB]
- FY 2016 IPPS Final Rule and Correction Notice Medicare DSH Supplemental Data File [ZIP, 788KB]
- Definition of Medicare Code Edits v33 [ZIP, 1MB]
- ICD-9 and ICD-10 MS-DRG Definitions Manual Files v33 (Updated 8/20/2015) [ZIP, 10MB]
- Monthly Summary of Charges for Charge Inflation Factor [ZIP, 3MB]
- FY 2016 HAC Reduction Program Information [ZIP, 98KB]
Help with File Formats and Plug-Ins
- ICD-10-CM/PCS MS-DRG v33 Definitions Manual Table of Contents - Full Titles - HTML Version (Updated 8/20/2015) - Opens in a new window
- Corrections to the ICD-10-CM/PCS MS-DRG v33 Definitions Manual Table of Contents – Full titles (Updated 8/20/2015) [PDF, 338KB]
- Additional Logic for MDC 14 Pregnancy, Childbirth & the Puerperium: MS-DRG 765 [PDF, 134KB]