Medicare Services

Medicare Inpatient Repricer

Using the Medicare Inpatient Repricer (MIR), Reden & Anders can re-adjudicate DRG-based inpatient claims to determine exactly what CMS would have paid for them—for every hospital at any recent date. The MIR can also project them through the fiscal year.

The Reden & Anders MIR transforms your inpatient data into a consistent format to give you timely data to make business-critical decisions.


Identify key drivers of Medicare DRG inpatient reimbursement

The Reden & Anders MIR allows you to determine what your reimbursement trend for Medicare DRG inpatient claims will be and see how your reimbursement would change for different charge structures.

Key features

  • Uses the latest publicly-available, hospital-specific data files released by CMS and all current CMS payment rules for DRG claims through the fiscal year
  • Payment methodology updated for the following fiscal year
  • Allows for input of your own inpatient hospital data
  • Visibility into payment levels and trends for peer and competitor hospitals
  • Allows you to update for different mixes of business and changes to charge trends

Flexible modeling tool

The Reden & Anders MIR models inpatient claims to track Medicare DRG payments over time, determine what caused changes in past DRG payments—mix of service, lengths of stay, or charge differences, and project Medicare DRG revenue through the end of the next fiscal year.

Benchmark and compare

In addition, the MIR can be used to model the impact of changes to your business on Medicare DRG payments, monitor keeping within CMS’s audit standards for outliers, compare different payers’ reimbursement levels to Medicare’s DRG level as a common benchmark, and evaluate provider contracts with managed care organizations.