DRGs for In-State, Acute Care Non-Critical Access Hospitals

July 5, 2011

Effective, 7/1/11, for all in-state, Acute Care non-Critical Access Hospitals, inpatient services will be reimbursed using the Diagnosis Related Grouping (DRG) methodology for admissions on or after 7/1/11.

The Emergency Rule implementing this methodology can be found online.

Critical Access Hospitals will continue to be reimbursed using the Prospective Interim Payment (PIP) methodology for inpatient and outpatient services.

Also effective 7/1/11, hospitals reimbursed under DRG methodology will be required to report if a particular Hospital Acquired Condition (HAC) was Present on Admission (POA). This change will align with Medicare’s guidelines for HACs.

If the HAC was acquired while in the hospital, then the appropriate DRG will be assigned, which will determine the correct reimbursement. If it is determined that the HAC was POA, the DRG reimbursement will not change.

Upon implementation of this requirement, providers will need to begin using the “Present on Admission” indicator in MIHMS when submitting claims.