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Reimbursement

Inpatient Hospital Payment Method for Mississippi Medicaid

Hospital Inpatient APR-DRG Alert: July 1, 2018 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, 2018:

  1. DOM will adopt V.35 of the 3M Health Information Systems APR-DRG Grouper and Hospital-Specific Relative Value (HSRV) weights.
  2. DOM will update the existing methodology used to assign pediatric and adult policy adjustors which is based on principal diagnosis codes and the age of the beneficiary.  The new methodology will use the APR-DRG assigned to the stay and the age of the beneficiary to assign a pediatric or adult Medicaid Care Category (as established by DOM.)  The Medicaid Care Category will be used to assign a policy adjustor to the inpatient stay.
  3. Charge cap:  If the sum of the APR-DRG base payment including effects of policy adjustors, APR-DRG cost outlier payment, APR-DRG day outlier payment, and transfer and/or prorated adjustments, if applicable, is more than the total billed charges on the claim, the total APR-DRG payment amount, net of medical education payments, will be limited to the total billed charges.
  4. The following APR-DRG parameters will be updated:
  • Base Payment – will change from $6,415 to $6,585
  • Neonate policy adjustor – will change from 1.45 to 1.40
  • DRG Cost Outlier Threshold – will change from $50,000 to $45,000
  • DRG Cost Outlier Marginal Cost Percentage – will change from 50% to 60%

DOM estimates the overall impact of the above changes will be a savings of $150,895 in state and federal funds.

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, 2018.

DOM is offering three APR-DRG update informational webinars. The sessions will show results from the previous year of the DRG payment method, outline the changes for Year 7, and provide billing and documentation tips. DOM strongly encourages each hospital to participate in one of the sessions.

To register for one of the three webinar training sessions listed below, RSVP to Lisa Nelson at (406)437-2780 or Lisa.Nelson@conduent.com. Please limit webinar attendance to one line per hospital. WebEx will be sent prior to the session.

Reimbursement 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 medicaid.ms.gov, Late Breaking News, and RA Banner Messages.

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