Inpatient Hospital Payment Method for Mississippi Medicaid
HOSPITAL INPATIENT APR-DRG ALERT – July 1, 2021 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, 2021:
1. DOM will adopt V.38 of the 3M Health Information Systems (3M HIS) APR-DRG Grouper and Hospital-Specific Relative Value (HSRV) weights
2. V.38 of the APR-DRG HSRV weights are substantially lower on average for Medicaid inpatient stays relative to V.35 (current for SFY 2021). In order to avoid substantial changes in the base price from year-to-year due to changes in the average relative weight, the Division has opted to implement a process to re-center the APR-DRG relative weights to a population average of 1.0 each year. The relative weights will still be based on the values published by 3M but will be adjusted so that the average weight across Mississippi Medicaid inpatient stays is 1.0. This new process will mean that the average APR-DRG relative weight will not change from year-to-year, which will reduce the need to adjust the base price each year. However, because this process will significantly increase the average weight in SFY 2022 relative to SFY 2021, the Division will need to make a one-time significant decrease in the base price to maintain budget neutrality.
3. The following APR-DRG parameters will be updated:
a. Base Payment – will change from $6,590 to $5,350. This change in the base price is designed to compensate for increased HSRV weights and will not affect overall payment levels.
b. Pediatric mental health policy adjustor – will change from 1.95 to 1.90 to maintain current payment levels
c. Adult mental health policy adjustor – will change from 1.50 to 1.45 to maintain current payment levels
d. Obstetrics policy adjustor – will change from 1.50 to 1.40 to maintain current payment levels
e. Normal Newborn policy adjustor – will change from 1.50 to 1.45 to maintain current payment levels
f. DRG Cost Outlier Threshold – will change from $53,500 to $60,000
g. DRG Cost Outlier Marginal Percentage – will change from 60% to 50%
DOM estimates the overall impact of the above changes will be a savings of $210,588 in state and federal funds, which is budget neutral to SFY 2021.
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, 2021.
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.
- APR-DRG Quick Tips
- APR-DRG 3M Grouper Settings
- APR-DRG Pricing Calculator V38 – Excel
- APR-DRG Pricing Calculator V38 – PDF
- APR-DRG Frequently Asked Questions (FAQs)
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.
- OPPS Provider Notice, Training Dates and Registration
- OPPS Provider Training Presentation
- SFY20 OPPS Quick Tips
- SFY20 OPPS FAQs