Mississippi Medicaid's proposed Hospital Inpatient APR-DRG Updates for July 1

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, 2017:

1. DOM will adopt V.34 of the 3M Health Information System APR-DRG Grouper.

2. DOM will adopt V.34 of the Health Care Acquired Conditions (HCAC) utility.

3. Low-side Outlier Payment Reduction – The APR DRG Base Payment may be reduced for low cost non-psych hospital inpatient stays when the DRG Base Payment exceeds the estimated cost of a stay.

4. Charge cap – The APR-DRG allowed amount, (the sum of the DRG Final Base Payment after low-side outlier payment reduction, plus DRG Cost Outlier payment, plus DRG Day Outlier payment), will be limited to the lower of the DRG Payment Amount or the total billed charges on the claim.

5. The following APR-DRG parameters will be updated:
   - Neonate policy adjustor – will be changed from 1.45 to 1.40
   - Low-side Outlier Threshold - $50,000
   - Low-side Outlier Marginal Cost Percent - 50%

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, 2017.

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

For more information, contact Janice Banks at  (601) 359-6046 or Janice.banks@medicaid.ms.gov.