Inpatient Hospital Payment Method for Mississippi Medicaid
HOSPITAL INPATIENT APR-DRG ALERT – July 1, 2020 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, 2020:
The following APR-DRG parameters will be updated:
a. Base Payment – will change from $6,574 to $6,590
b. Pediatric mental health policy adjustor – will change from 2.00 to 1.95
c. Adult mental health policy adjustor – will change from 1.60 to 1.50
d. DRG Cost Outlier Threshold – will change from $47,000 to $53,500
DOM estimates the overall impact of the above changes will be a savings of $2,846,599 in state and federal funds which will be used to fund an increase in payments for outpatient community-based mental health services. This savings represents less than 0.5% of the DOM hospital inpatient budget.
Due to significant changes in the clinical logic and relative weights from version 35 to version 37 of the 3M APR-DRG grouper, DOM will not update to version 37 on July 1, 2020. The changes to the logic and weights in version 37 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 additional year in order to maintain stability in DRG payments. DOM will assess the impact of version 38 of the APR-DRG grouper and weights when they are released in October 2020 and will consider whether to update to that version or move to Mississippi specific weights.
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, 2020.
- Hospital Reimbursement Policy Updates – July 1, 2020
- APR-DRG Provider Update Presentation
- APR-DRG Quick Tips
- APR-DRG 3M Grouper Settings
- APR-DRG Pricing Calculator V35 – Excel
- APR-DRG Pricing Calculator V35 – 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