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Custom DRG Tables

The Custom DRG Tables feature allows organizations to define and manage their own DRG weights and lengths of stay, which can override or supplement standard CMS DRG data for contract modeling.

Overview

Custom DRG Tables enable you to create varied pricing scenarios by modifying the base DRG parameters used in reimbursement calculations. You can maintain multiple tables for different contracts or scenarios, each spanning multiple fiscal years.

Creating a New Table

To create a custom DRG table, you clone data from an existing CMS fiscal year as a starting point.

  1. Navigate to Customizations → Custom DRG Tables in the dashboard.
  2. Click the Create New button.
  3. In the modal:
    • Contract ID: Enter a unique identifier for this table (e.g., COMMERCIAL-A).
    • Payment System: Select the system (IPPS, IPF, or LTCH).
    • Source Year: Choose the CMS fiscal year to clone data from (e.g., 2024).
  4. Click Create Table.

The system will copy all standard DRG entries from the selected year into your new custom table.

Multi-Year Support

You can manage data for multiple fiscal years under a single Contract ID. This ensures continuity for contracts that span multiple years.

Adding a Year

To add a new fiscal year to an existing table: 1. Select the Table ID you want to update from the dropdown. 2. Click the Add Year button. 3. The modal will open with the Contract ID and Payment System pre-filled and locked. 4. Select the Source Year you want to add. 5. Click Add Year.

[!IMPORTANT] You cannot add a fiscal year that already exists for the selected Contract ID.

switching Years

When viewing a table that has multiple years: - Use the Year selector (next to the Table ID selector) to switch between fiscal years. - The most recent year is selected by default when you load a table.

Managing DRG Entries

Once a table is created, you can customize individual DRG entries.

Viewing and Filtering

  • Search: Enter a specific DRG code in the search bar to find an entry.
  • Lists: Browse the paginated list of all DRGs in the table.

Editing Entries

  1. Click the Edit button on any DRG row.
  2. In the edit dialog, you can modify:
    • Weight: The relative weight of the DRG.
    • GMLOS: Geometric Mean Length of Stay.
    • AMLOS: Arithmetic Mean Length of Stay.
    • Flags:
      • Low Volume: Toggle low volume adjustment.
      • Post Acute Care (PAC): Toggle post-acute care transfer policy.
      • Special Payment PAC: Toggle special payment logic.
  3. Click Save Changes to apply your updates.

[!NOTE] Changes apply only to the specific year and table you are editing. They do not affect other years or the standard CMS data.

Exporting Data

You can export your custom table data for external analysis or reporting.

  1. Select the Table ID and Year you want to export.
  2. Click the Download CSV button.
  3. A CSV file containing all DRG entries for that year will be downloaded.

Permissions

  • View Access: All users in your organization can view custom DRG tables.
  • Write Access: Only users with specific permissions can create, edit, or delete tables. If you see a "Read-only access" notice, contact your administrator.