 Passed by the Florida Legislature in 2012  Transitioned Medicaid hospital inpatient payment from per diem to a DRG system. Payments are now made based.

Slides:

Advertisements

Similar presentations

AHCCCS Implementation of APR-DRG Payments

Advertisements

Inpatient Prospective Payment System: To Reform or Refine? Parashar Patel Vice President, Reimbursement & Outcomes Planning Boston Scientific Corporation.

Proposed Changes to Medicaid Hospital Rates. Presenters Will Callicoat Director, Financial Policy WSHA Claudia Sanders Sr. Vice President, Policy Development.

13. Healthcare Sector Costs Payments and revenue received by physicians and healthcare entities represent the cost of business for the government, insurance.

Anthem Blue Cross and Blue Shield Hospital Assessment Fee [Insert image of members] January 2015.

Medicare Inpatient Hospital Payment: What Changes Can Your Hospital Expect?

HOSPITAL PAYMENT MODERNIZATION CONNECTICUT’S OPPORTUNITY FOR CHANGE November 2013.

Ronald H Kilmer, RN, Ret.. "Medicare won't pay if we charge them for observing you, because it's not a medical necessity.."

Medicare GME PRIMER OGME Development Initiative. Direct Graduate Medical Education (DGME) Payment Payment for Medicare’s share of the costs of training.

Vivian Y. Wu, PhD, MS Assistant Professor Schaeffer Center of Health Policy and Economics Sol Price School of Public Policy University of Southern California.

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM DRG Workgroup Meeting November 18, 2013.

5/11/20151 ALL YOU EVER WANTED TO KNOW ABOUT BILLING & REIMBURSEMENT BUT WERE AFRAID TO ASK Presented by: Evelyn Alwine, RHIA CHDA Director Revenue Cycle.

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM DRG Workgroup Meeting December 17, 2013.

WASHINGTON STATE HEALTH CARE AUTHORITY WSHA Rebasing Task Force Meeting July 15, 2013.

From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing:Cosmetic Surgery Billing Package and Cosmetic Surgery.

Centre for Health Economics Modelling the impact of being obese on hospital costs Katharina Hauck Bruce Hollingsworth.

Comparing the Use of Diagnostic Tests in Canadian and US Hospitals Steven J Katz, Laurence F McMahon and Willard G Manning Medical Care. 34(2): ,

Clinical Documentation. Objectives Upon completion of this presentation participants will be able to: Define Clinical Documentation State the purpose.

2010 UBO/UBU Conference Title: How to Determine Charges Using the VA-DoD Inpatient Institutional Payment Calculator Session: R

1 Managed Health Care Pricing for Provider Arrangements Presented by Vanessa Olson Seminar on Health and Managed Care October 18, 1999.

1 Reimbursing Health Care Providers It is all about striking the right balance between economic incentives for over-treatment and under- treatment Yaseen.

25 May 2010Hospital Financing in Germany: The G-DRG System1 Wilm Quentin, M.D., MSc HPPF Department of Health Care Management, Technical University Berlin.

Medicaid Hospital Utilization Review and DRG Audits: Frequently Asked Questions The Department of Medical Assistance Services Division of Program Integrity.

Diagnostic Related Group Inpatient Hospital Reimbursement

Recommendations on Minimum Data Recording Requirements in Hospitals from the Directorate of Health in Iceland: Is it possible to use Hospital Patient Registry.

Uniform Coding and Simplified Pricing HEALTH AUTHORITY – ABU DHABI Health Systems Finance May, 2007.

Well Managed, Efficient Washington Hospitals Washington hospitals as a group consistently demonstrate lower rates of admission, shorter stays and lower.

Implementing Medicare Hospital Payment Systems

-1- Washington State Medicaid Inpatient Reimbursement System Study Phase 2 Study Methodology Redesign Update September 26, 2006.

Chapter 23 Includes Supplements 4 through 8. The Revenue Equation.

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Prof Ric Marshall Interim.

Washington State Hospital Association The Medicaid Rebasing: What It Will Mean For Your Hospital Webcast February 24, 2014.

Introduction to Medical Management – PPS and DRGs ISE 468 ETM 568 Spring 2015 Prospective Payment System Diagnosis-Related Groups.

Snapshot of IMS LifeLink Claims Database 10% Random Sample

DRG as a quality indicator 4th Nordic Casemix Conference 3-4th June 2010 Paasitorni, Helsinki, Finland Lisbeth Serdén National Board of Health and Welfare.

Chapter 15 HOSPITAL INSURANCE.

How Much Does Medicare Pay Hospitals for Adverse Events? Building the Business Case for Investing in Patient Safety Improvement Chunliu Zhan, MD, PhD,

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Linda Best

©2008 Thomson Reuters Psychiatric Care in General Hospitals With and Without Psychiatric Units: How Much and for Whom? Tami L. Mark, Thomson Reuters Elizabeth.

Arizona Health Care Cost Containment System DRG-Based Inpatient Hospital Payment System Project Overview June 14, 2012.

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Transition to Inpatient DRG Payment Methodology.

Rhode Island Nursing Facility Payment Methodology: Status Update March 15, 2012.

Nurse Executive Case Management Workshop Home Town Health Anderson Goodwill Conference Center Macon, Georgia Prepared by: Sherry A. Milton, RHIA Milton.

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.

“RECRUITS: ARE YOU READY TO MAKE CHANGES IN YOUR HOSPITAL?” "I CAN'T HEAR YOU!" Medicaid and Medicare cuts are projected to exceed $123 billion over the.

CYE 15 APR-DRG Implementation The APR-DRG payment methodology will be implemented for all acute/general hospitals (provider type 02) The same payment methodology.

What is Clinical Documentation Integrity? A daily scavenger hunt.

Overview of Hospice Payment Reform For VNAA Roundtable Robert J. Simione Managing Principal Simione Healthcare Consultants HOSPICE.

Understanding the Readmissions Reduction Program Kimberly Rask, MD PhD Medical Director Alliant | GMCF cover.

ICD-10 Implementation: Opportunities and Challenges Diane Stollenwerk, MPP NAHDO Conference - October 28, 2015 Input Your Data. Output Your Website.

1 New Inpatient Billing Guidance For Inpatient Services Provided Under VA/DoD Health Care Resource Sharing Agreements Presented by the UBO Support Team.

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Medical Manager Unit 6 ICBS 170. Medical Manager  Billing Routines Generation of bills and statements sent to guarantors and insurance companies Patient.

Vantage Care Positioning System®: Make Your Case with Medicare Spending Data November 2014 avalere.com.

Printed by A Follow-Up Study of Patterns of Service Use and Cost of Care for Discharged State Hospital Clients in Community-Based.

3M Global Information Technology 11 © 3M. All Rights Reserved. 3M Global Information Technology Florida Hospital Association 3M Health Information Systems.

Program for Evaluating Payment Patterns Electronic Report Program for Evaluating Payment Patterns Electronic Report Inpatient Psychiatric Facility (IPF)

CMI usage and calculations By: Deborah Balentine M.Ed, RHIA, CCS-P

Relative Profit Margins and the Allocation of Hospital Outpatient and Inpatient Services John F. Scoggins, PhD Diane P. Martin, PhD University of Washington.

3 - 1 CHAPTER 3 Paying for Health Services Basic insurance concepts Third-party payers Reimbursement (payment) approaches Medicare payment methods Impact.

Proposed Medicaid Hospital Outpatient Prospective Payment System

LESSON 6-2 Inventory Costing

Potentially Preventable readmissions policy

WYOMING Medicaid APR DRG Implementation

Introduction to Medical Management – PPS and DRGs

ICD-10 Updates.

LESSON 6-2 Inventory Costing

Hospital Inpatient DRG Reconciliation Sandy Sage RN March 23, 2016.

FIRST-IN, FIRST-OUT INVENTORY COSTING METHOD

DRGs + Four Factors in Hospital Improvement

Presentation transcript:

 Passed by the Florida Legislature in 2012  Transitioned Medicaid hospital inpatient payment from per diem to a DRG system. Payments are now made based on acuity not on length of stay.  Applies to all hospitals except inpatient psychiatric hospitals  Implemented in 2013

 Payment based on the following: ◦ Diagnosis ◦ Surgical procedures performed, if any ◦ Patient age ◦ Patient gender ◦ Discharge status

 Each diagnosis is assigned a DRG code  Each DRG code is assigned a relative weight which indicates the amount of resources required to treat a patient with that diagnosis  DRG rate for an average Florida hospital admission is 1.0 and can be used to determine the complexity of each diagnosis.  Example: If the base payment is $3000 and a DRG has a relative weight of 2.0 the stay requires 2 x the resources as an average stay so the payment would be $6000.

 DRG payments reward hospitals that decrease the cost of a stay  Hospitals that provide complete and accurate coding of accounts benefit if they have captured all of the patient’s diagnoses and conditions  If you are not capturing the acuity of the patient with your coding you may be losing money

 DRG base payments can be increased by a “Policy Adjustor” multipliers that are intended to help protect access to care.  Provider Adjusters are applied for rural hospitals and hospitals with high Medicaid utilization  Transfers: Payment is usually decreased if a patient is transferred  Cost outlier adjustments may be applied  Charge cap: payment will be the lesser of DRG payment or charge amounts and%20Awareness%20Guide.pdf

%20Changes.pdf New for Fiscal year 2015/2016

 Original base payment $  2015 General Appropriations Act (GAA) required AHCA to apply adjustments to the base rate, complex calculation  3/2016 through 6/2016 base rate recalculated will be a decrease of 4.9% $

Get Medicaid updates and alerts by ahca.myflorida.com/Medicaid/alerts/alerts_edit.shtml Archive of alerts: erServices/Provider_ProviderSupport/Provider_Prov iderSupport_ProviderAlerts/tabId/48/Default.aspx

 DRG Pricing Page:  ves/Provider_DRG/tabId/91/Default.aspx ves/Provider_DRG/tabId/91/Default.aspx  DRG Fiscal Year Changes [459KB] *New 08/03/15* DRG Fiscal Year Changes [360KB] DRG Quick Reference and Awareness Guide [1739KB] DRG Frequently Asked Questions (FAQ) [991KB] Understanding Diagnosis Related Groups (DRG) Training Presentation [1587KB] DRG Field Services Representatives Area Map [390KB] DRG Fiscal Year Changes DRG Fiscal Year Changes DRG Quick Reference and Awareness Guide DRG Frequently Asked Questions (FAQ) Understanding Diagnosis Related Groups (DRG) Training Presentation DRG Field Services Representatives Area Map Public/DRG%20PRICING/Understanding_Diagnosis_Related_G roups_(DRG)_updates_post_0701.pdf