Table 3 Potentially lost relative weighting factors from inadequate DRG modifiers. Summation of DRG relative weighting factors (RWF) between billed DRG codes and algorithm-proposed DRG codes with modifiers. Estimation of revenue loss was calculated based on payor-specific estimated dollars per RWF
Upgrade Type | Payor | Count | Added points | $/Unit | Additional Revenue |
|---|---|---|---|---|---|
Upgrade Base to CC | MEDI-CAL | 254 | 75.4941 | $7,500.00 | $566,205.75 |
MEDICARE | 198 | 72.7078 | $10,000.00 | $727,078.00 | |
PRIVATE | 583 | 183.8997 | $20,000.00 | $3,677,994.00 | |
Upgrade Base to MCC | MEDI-CAL | 87 | 133.8745 | $7,500.00 | $1,004,058.75 |
MEDICARE | 75 | 54.3528 | $10,000.00 | $543,528.00 | |
PRIVATE | 32 | 46.6599 | $20,000.00 | $933,198.00 | |
Upgrade CC to MCC | MEDI-CAL | 134 | 201.6356 | $7,500.00 | $1,512,267.00 |
MEDICARE | 296 | 376.6575 | $10,000.00 | $3,766,575.00 | |
PRIVATE | 355 | 497.484 | $20,000.00 | $9,949,680.00 | |
$22,680,584.50 |