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Reimbursement

Inpatient Hospital Payment Method for Mississippi Medicaid

***The following updated APR-DRG parameters are effective July 1, 2026.

The Mississippi Division of Medicaid (DOM) updated the hospital inpatient APR-DRG payment methodology for the payment of hospital inpatient claims for discharges effective on and after July 1, 2026:

  1. DOM adopted V.43 of the Solventum APR-DRG Grouper and Hospital-Specific Relative Value (HSRV) weights.
  2. Re-centered V.43 HSRV weights to a population Case-Mix Index (CMI) of 1.0
  3. The following APR-DRG parameters changed:
    1. Base Payment – from $5,400 to $5,608
    2. Neonate policy adjustor – from 1.60 to 1.44
    3. DRG Cost Outlier Threshold – from $66,000 to $88,000

Please keep in mind that hospitals are not required to purchase Solventum software for payment of claims; however, all hospitals that have purchased the Solventum software should ensure their internal systems are updated to reflect all changes that occur for hospital discharges beginning on and after July 1, 2026.

 

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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