CMI Impact

Case Mix Index (CMI) is the average of DRG weights of all inpatients. It indicates the complexity of the cases dealt by the hospital.

  • CMI is directly impacted by specificity of DRGs
  • Higher weighted DRGs (DRGs with CC or MCC) can be assigned by coders only if supported by physician documentation
  • A low or reduced CMI reflects low specificity diagnoses assignment, poor documentation quality, no or inefficient CDI program
  • The reimbursement received by a hospital is based on the multiplication of the DRG weight for each inpatient case and the blended rate agreed upon between the hospital and the Payers/CMS
  • CMI therefore directly impacts the reimbursement received by the hospital
  • Inability to monitor your CMI in real-time?
  • Not aware of what factors cause fluctuations in your CMI?
  • Do you feel that your CMI does not reflect the true picture of your hospital’s patient population and care?
  • NLP based AGS solutions deploy cutting edge technologies which helps improve CMI in the
    following manner:
    • Automated suggestion of specific codes instead of generic codes
    • Improved CC/MCC capture rate
    • Improves DRGs by built-in DRG analysis tool
    • Real-time dashboards which help in providing improving opportunities in real-time

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Related resources

The Rcm Maturity Framework
The RCM Maturity Framework: A 4-Stage Journey to Digital Transformation and Operational Excellence

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