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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:

  1. DOM will adopt V.34 of the 3M Health Information System APR-DRG Grouper.
  2. DOM will adopt V.34 of the Health Care Acquired Conditions (HCAC) utility.
  3. 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.
  4. 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.
  5. The following APR-DRG parameters will be updated:
    1. Neonate policy adjustor – will be changed from 1.45 to 1.40
    2. Low-side Outlier Threshold – $50,000
    3. 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.

Finance Archive

Outpatient Hospital Payment Method for Mississippi Medicaid

Hospital Outpatient Prospective Payment System (OPPS) Date Bundling Update

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, Late Breaking News, and RA Banner Messages.

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)