How to compare MS-DRG payments
Pick what to hold constant. DRG vs DRG prices up to four MS-DRGs for the same claim and the same stay at one hospital, which is how a billed DRG is checked against a regrouped one or a whole severity family is laid out. Hospital vs hospital prices one DRG at up to four hospitals and shows how the wage index, the teaching and low-income add-ons, uncompensated care and pass-through costs move the payment. FY2026 vs FY2027 prices the same claim with a discharge date in each rate year, each on the hospital record in force that day.
In the saved sample, a five-day sepsis stay discharged October 15, 2026 with $98,000 in covered charges pays $21,591.04 under Original Medicare at Houston Methodist Hospital as DRG 871 and $13,828.20 as DRG 872: $7,762.84 between the two severity levels for the same stay. The same DRG 871 claim pays $28,176.18 at NewYork-Presbyterian Hospital, where the wage index is 1.4269, and $18,716.21 at HCA Houston Healthcare Pearland, a non-teaching hospital in Houston Methodist's own labor market. Discharged on September 15, 2026 instead, it pays $21,838.88 under FY2026 rates: $247.84 more than under FY2027, mostly because the hospital's per-diem pass-through fell.
Every column shows two totals. Original Medicare is the full fee-for-service payment. Medicare Advantage, out of network, is the MA allowed amount for an out-of-network hospital, before the member's cost sharing: it leaves out the operating IME and the part of the per-diem pass-through that Medicare pays the hospital directly. The two can rank hospitals differently: in the sample, Houston Methodist is second of three under Original Medicare and lowest under Medicare Advantage.
Questions
Why does the same MS-DRG pay differently at two hospitals?
Medicare adjusts every DRG payment for the hospital's labor market (the wage index), its teaching and low-income add-ons (IME and DSH), capital, uncompensated care and per-diem pass-through costs. The comparison shows each of those amounts side by side, so you can see which one drives the difference.
Which rate year does a discharge use?
Discharges from October 1, 2026 through September 30, 2027 use FY2027 IPPS rates, and discharges from October 1, 2025 through September 30, 2026 use FY2026 rates. Each column is priced on the hospital's provider record in force on its discharge date.
What does Medicare Advantage, out of network mean here?
It is the Medicare Advantage allowed amount for an out-of-network hospital's stay, before the member's cost sharing: the Original Medicare amount less the operating IME and the part of the per-diem pass-through that Medicare pays the hospital directly.
Why does DRG vs DRG use the same covered days in every column?
A billed DRG and a regrouped DRG describe the same stay, so the comparison holds the covered days constant. With covered days left blank, every column uses the reference DRG's geometric mean length of stay, rounded to whole days, and the comparison says so.
How many priced claims does a comparison use?
One per column, so a four-DRG comparison uses four. Columns already priced in your session are reused at no cost, a hospital CCN typed by hand is first checked with a free lookup, and the free tier allows 40 priced claims a day.