2.  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

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

4.  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.

5.  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

6.  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 http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/DRG%20PRICING/Quick%20Reference%20 and%20Awareness%20Guide.pdf

7. http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/DRG%20PRICING/Fiscal%20Year%202015 -2016%20Changes.pdf New for Fiscal year 2015/2016

8.  Original base payment $ 3230.64  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% $ 3078.81

9. Get Medicaid updates and alerts by email: ahca.myflorida.com/Medicaid/alerts/alerts_edit.shtml Archive of alerts: http://portal.flmmis.com/FLPublic/Provider_Provid erServices/Provider_ProviderSupport/Provider_Prov iderSupport_ProviderAlerts/tabId/48/Default.aspx

10.  DRG Pricing Page:  http://portal.flmmis.com/FLPublic/Provider_AgencyInitiati ves/Provider_DRG/tabId/91/Default.aspx http://portal.flmmis.com/FLPublic/Provider_AgencyInitiati ves/Provider_DRG/tabId/91/Default.aspx  DRG Fiscal Year 2015-2016 Changes [459KB] *New 08/03/15* DRG Fiscal Year 2014-2015 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 2015-2016 Changes DRG Fiscal Year 2014-2015 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 http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/ Public/DRG%20PRICING/Understanding_Diagnosis_Related_G roups_(DRG)_updates_post_0701.pdf