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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:

  • Base Payment – will change from $6,585 to $6,731
  • Neonate policy adjustor – will change from 1.40 to 1.25
  • Pediatric mental health policy adjustor – will change from 2.00 to 1.85
  • Adult mental health policy adjustor – will change from 1.60 to 1.50
  • DRG Cost Outlier Threshold – will change from $45,000 to $48,500
  • DRG Day Outlier per diem – will change from $450 to $675

DOM estimates the overall impact of the above changes will be a savings of $26,282 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. DOM will begin educating hospitals on the potential impacts on reimbursement resulting from version 36 during the APR-DRG training sessions for the July 1, 2019 updates. Additional claims analysis will then 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.

Training will be scheduled with dates to be provided.  Hospitals will be notified via e-mail and the DOM website.

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, Late Breaking News, and RA Banner Messages.


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