A case mix group (CMG) is used in
patient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...
classification system to group together patients with similar characteristics. This provides a basis for describing the types of patients a
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
or other
health care provider
A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive ...
treats (its case mix). Case mix groups are used as the basis for the Health Insurance Prospective Payment System (HIPPS) rate codes used by
Medicare in its prospective payment systems.
"Definition and Uses of Health Insurance Prospective Payment System Codes (HIPPS Codes),"
CMS Division of Institutional Claims Processing, Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
, 3/17/2008
Case mix groups are designed to aggregate acute care inpatients that are similar clinically and in terms of resource use. Acute care inpatients are assigned to groups based on clinical and administrative data collected via the Discharge Abstract Database (DAD).
References
Medicare and Medicaid (United States)
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