- Long term care reimbursement method for Mississippi Medicaid
- Payment Error Rate Measurement (PERM)
- Recovery Auditor Contractors (RAC)
- Mississippi Medicaid State Level Registry for Provider Incentive Payments
Inpatient Hospital Payment Method for Mississippi Medicaid
Hospital Inpatient APR-DRG Alert: July 1, 2017 updates
The Mississippi Division of Medicaid (DOM) is proposing the following changes to the hospital inpatient APR-DRG payment methodology effective for the payment of hospital inpatient claims for discharges on and after July 1, 2017:
- DOM will adopt V.34 of the 3M Health Information System APR-DRG Grouper.
- DOM will adopt V.34 of the Health Care Acquired Conditions (HCAC) utility.
- Low-side Outlier Payment Reduction – The APR DRG Base Payment may be reduced for low cost non-psych hospital inpatient stays when the DRG Base Payment exceeds the estimated cost of a stay.
- Charge cap – The APR-DRG allowed amount, (the sum of the DRG Final Base Payment after low-side outlier payment reduction, plus DRG Cost Outlier payment, plus DRG Day Outlier payment), will be limited to the lower of the DRG Payment Amount or the total billed charges on the claim.
- The following APR-DRG parameters will be updated:
- Neonate policy adjustor – will be changed from 1.45 to 1.40
- Low-side Outlier Threshold – $50,000
- Low-side Outlier Marginal Cost Percent – 50%
Hospitals are not required to purchase 3M software for payment of claims; however, all hospitals that have purchased the 3M software should ensure their internal systems are updated to reflect all changes that occur for hospital discharges beginning on and after July 1, 2017.
- APR-DRG notice of parameter updates, training dates and registration – May 24, 2017
- APR-DRG training presentation – June 2017
- APR-DRG frequently asked questions – July 1, 2017
- APR-DRG quick tips – July 1, 2017
- APR-DRG pricing calculator V34 – Excel
- APR-DRG pricing calculator V34 – PDF
Outpatient Hospital Payment Method for Mississippi Medicaid
Hospital Outpatient Prospective Payment System (OPPS) Date Bundling Update
- OPPS Date Bundling Background and Training Opportunity Information
- OPPS Date Bundling Provider Billing Guide
- OPPS Date Bundling Training Presentation
Hospital Outpatient Prospective Payment Fiscal Year 2016 Update Alert
The Mississippi Division of Medicaid Outpatient Prospective Payment System (OPPS) fee schedule will be updated July 1, 2015 for Medicare Outpatient Addendum B or C changes effective April 1, 2014, as required by the State Plan.
The Mississippi Division of Medicaid will implement is expecting to move forward with OPPS Phase 2 in the near future.
Hospitals will be notified of all information related to these changes and training session dates via e-mail, the DOM website medicaid.ms.gov, Late Breaking News, and RA Banner Messages.
- OPPS Phase 2 training presentation
- OPPS billing quick tips
- View previous outpatient hospital notifications
Federal Medical Assistance Percentage
Each state runs their own Medicaid program within federal guidelines, jointly funded by state and federal dollars. For Medicaid, the Federal Medical Assistance Percentage (FMAP) is used to calculate the amount of federal matching funds for state medical services expenditures. The Social Security Act requires the Secretary of Health and Human Services to calculate and publish the FMAP annually.
The federal fiscal year (FFY) matching funds percentage rates applicable to medical service claims for the Mississippi Medicaid program are as follows:
- FFY 2016, effective Oct. 1, 2015 = 25.83 percent (state) / 74.17 percent (federal)
- FFY 2015, effective Oct. 1, 2014 = 26.42 percent (state) / 73.58 percent (federal)
- FFY 2014, effective Oct. 1, 2013 = 26.95 percent (state) / 73.05 percent (federal)
- FFY 2013, effective Oct. 1, 2012 = 26.57 percent (state) / 73.43 percent (federal)
- FFY 2012, effective Oct. 1, 2011 = 25.82 percent (state) / 74.18 percent (federal)