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Reimbursement

Inpatient Hospital Payment Method for Mississippi Medicaid

***There are no APR-DRG updates for July 1, 2024. The APR-DRG parameters below are currently in effect.

HOSPITAL INPATIENT APR-DRG ALERT – July 1, 2023, 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, 2023:

  1. DOM will adopt V.40 of the 3M Health Information Systems (3M HIS) APR-DRG Grouper and Hospital-Specific Relative Value (HSRV) weights
  2. Re-center V.40 HSRV weights to a population Case-Mix Index (CMI) of 1.0
  3. The following APR-DRG parameters will be updated:
    1. Base Payment – will change from $5,350 to $5,400
  4. Adult mental health policy adjustor – will change from 1.45 to 1.50
  5. Obstetrics policy adjustor – will change from 1.40 to 1.50
  6. Normal Newborn policy adjustor – will change from 1.45 to 1.55
  7. Neonate policy adjustor – will change from 1.40 to 1.60
  8. Rehab policy adjustor – will change from 2.00 to 2.10
  9. DRG Cost Outlier Threshold – will change from $60,000 to $66,000
  10. DRG Cost Outlier Marginal Percentage – will change from 50% to 45%

When using a calendar year 2021 claims data set, DOM estimated the overall impact of the above changes would be a savings of $137,954 in state and federal funds.

Please keep in mind that 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, 2023.

Sessions regarding APR-DRG payment updates will be scheduled with dates to be provided.  Hospitals will be notified via e-mail and the DOM website www.medicaid.ms.gov.

Reimbursement Archive

Outpatient Hospital Payment Method for Mississippi Medicaid

Hospital Outpatient OPPS Alert – July 1, 2019, Updates

The Mississippi Division of Medicaid (DOM) is proposing the following changes to the hospital outpatient OPPS payment methodology effective for the payment of hospital outpatient claims with dates of service on and after July 1, 2019:

1.  Use the Medicare Addendum B effective as of January 1 of each year as published by the Centers of Medicare and Medicaid Services (CMS),
2.  Apply the multiple discounting policy to dental procedures billed on the hospital outpatient claim to price the highest allowed dental procedure at 100% of the allowed amount or published fee and price all subsequent dental procedures at 25% of the allowed amount or published fee.

DOM estimates the overall impact of the above changes will be a savings of $2,214,139 in state and federal funds.

Training will be scheduled with dates to be provided.  Hospitals will be notified via e-mail and the DOM website www.medicaid.ms.gov.

Reimbursement Archive

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