The Department of Health Care Policy and Financing (the Department) is currently working with the fiscal agent, Xerox State Healthcare, to implement All Patient Refined-Diagnosis Related Group (APR-DRG) into the current Medicaid Management Information System (MMIS). The APR-DRG is expected to become effective for discharge dates on or after January 1, 2014.
In parallel, the Department has contacted the Public Consulting Group, Inc. (PCG) to assist with the new inpatient payment methodology. Public Consulting Group is tasked with gathering provider feedback on the APR-DRG system implementation, payment policy, and provider education. For information regarding provider outreach, dates and how to participate, refer to the Provider Outreach Calendar.
The APR-DRG system must be implemented before the Internal Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is implemented on October 1, 2014. Current Centers for Medicare and Medicaid Services Diagnosis Related Group (CMS-DRG) system does not support ICD-10-CM codes;therefore claims with ICD-10-CM codes would not be processed. The Department wants to implement the APR-DRG system before ICD-10-CM is implemented so that a number of claims may be processed under the new system and re-weight calculations may be completed before the ICD-10-CM deadline.
Please refer to the Provider Bulletins section for further updates.
APR-DRG Implementation Tasks
|Claims System Business Needs Assessment||Completed|
|Claims System APR-DRG Project Requirements||Completed|
|MMIS APR-DRG Technical Specifications||Completed|
|Claims System APR-DRG Test Strategy||Completed|
|Claims System APR-DRG Test Plan||Completed|
|MMIS and Claims Processing Testing Phase||Completed|
|Claims System Test Results Review||Pending|
|Claims System Test Results Approval||Pending|
|Migration of APR-DRG into MMIS Production||Target: 12/31/13|
|IP/OP Hopsital Billing Manual Update||In Progress|
|System Documentation Update||In Progress|
|Post-Implementation Verification Review||In Progress|