Inpatient Hospital Per Diem Reimbursement Group

Implementation of Per Diem Update

 

November 21, 2019

An interim solution has been developed to price claims with admit dates of July 1, 2019, and beyond, using the per diem methodology until a permanent solution is implemented in 2020. The solution is currently being tested with the assistance of two (2) providers. Once implemented, claims will show in a suspended status for a short time until the claims are priced manually. 

Contact Elizabeth Quaife at Elizabeth.Quaife@state.co.us with additional questions.

October 15, 2019

We appreciate everyone’s patience while we await system updates to be completed. Currently, all Long Term Acute Care (LTACs) and Rehabilitation hospitals enrolled with Healthfirst Colorado will receive interim payments under the old APR-DRG reimbursement methodology. When the system updates have been completed, we will announce a meeting via email and web posting to discuss the requirements for split-billing claims that span the implementation date of July 1, 2019, and mass adjustment schedule of all claims with admit/discharge date on/after July 1, 2019.  

We have almost completed the update process and will have a date of system implementation by the end of October. Once we have received a date we will post to the Inpatient Per Diem Webpage and email everyone on our Per Diem provider list. The system update will have to be retroactively effective to July 1, 2019.

July 1, 2019

The interChange system has not been updated to accommodate the new Per Diem rates or split-bill capability of claims that cross over the implementation date of July 1, 2019. During the June 25, 2019, Per Diem Provider Meeting, the Department instructed Providers to continue to bill as normal until written instructions from the Department are communicated on how to complete the split-bill of claims that crossover the July 1, 2019 implementation date. Contact Elizabeth Quaife at Elizabeth.Quaife@state.co.us for any questions or concerns. 

May 29, 2019

After careful review of the feedback received from the last Per Diem Engagement Meeting held May 7, 2019, the Department has decided that the Long Term Acute Care Hospitals, Rehabilitation, Hospitals, and Spine/Brain Injury Treatment Hospitals will need to split bill any hospital stays that cross over the implementation date. This means that any client admitted prior to July 1, 2019, and discharged after June 30, 2019, would have two different claims. One claim will have a discharge date of June 30, 2019, and will use the APR-DRG methodology to calculate the claim payment. The second claim will have an admission date of July 1, 2019, and utilize the new per diem methodology to calculate the payment for the remainder of the stay. Contact Elizabeth Quaife at Elizabeth.Quaife@state.co.us for any questions or concerns. 

 

Inpatient Per Diem Rates FY 2019-20

Inpatient Hospital Base Rates 7.1.2018-6.30.2019

Per Diem to APR-DRG Calculator

Stepdown to Rate Guide

 

Inpatient Per Diem Rate Meetings 2019

The next Inpatient Hospital Per Diem Reimbursement Meeting is set for Tuesday, June 25, 2019, 2.00pm - 3.00pm 

Webinar Link 

Conference Line: 1-877-820-7831 Passcode 294442#

 

News and Upcoming Dates 

  • Proposed Rule Update
  • Specialty Hospital Engagement Meetings

 

For questions regarding rates and their calculations please contact Elizabeth Quaife at Elizabeth.quaife@state.co.us

 

Related Links: Links to Inpatient Hospital Rates Page , Outpatient Hospital Rates Page and Hospital Stakeholder Engagement Page