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Reimbursement

Inpatient Hospital Payment Method for Mississippi Medicaid

Hospital Inpatient APR-DRG Alert: July 1, 2019 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, 2019:

The following APR-DRG parameters will be updated:
a. Base Price – will change from $6,585 to $6,574
b. DRG Cost Outlier Threshold – will change from $45,000 to $47,000

DOM estimates the overall impact of the above changes will be a savings of $22,538 in state and federal funds.

Due to significant changes in the clinical logic and relative weights from version 35 to version 36 of the 3M APR-DRG grouper, DOM will not update to version 36 on July 1, 2019.  The changes to the logic and weights in version 36 would have a substantial impact on hospital reimbursement; as a result DOM has decided to remain on version 35 of the APR-DRG grouper and weights for an extra year in order to study how best to adapt to the new logic and weights.  Additional claims analysis will be performed using the version 37 grouper when it becomes available, to determine changes in APR-DRG parameters that will be necessary for the July 1, 2020 APR-DRG updates.

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, 2019.

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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