M'Caid as DRG payor

paxnerospaxneros
in CDI Talk Archive
A question for those of you who are reviewing based on DRG payors:

Are you or have you added M'Caid into your Mix?

I am in the State of Florida and as of December 1st M'Caid will become a DRG payor. So, curious as to others who may have/or will be adding this into your review mix. It will greatly increase our daily review census.

Thanks,

Norma T. Brunson, RHIA,CDIP,CCDS

Comments

  • Unknown
    edited May 2016
    From the two facilities that I have worked at in NC, we added Medicaid about 3 or 4 years ago.
  • paxnerospaxneros
    Actually, I will amend my question slightly as I am still researching this topic.

    It seems a plan is due Dec. 1st, 2012 for a possible implementation of July 1st 2013.

    "The Agency for Health Care Administration (AHCA) has retained MGT of America, Inc. in partnership with Navigant to develop models for consideration, with a plan published by December 1, 2012. The target date for implementation is July 1, 2013." http://www.fha.org/health/medicaid_drg.php

    NTB
  • sharon.colesharon.cole
    edited May 2016
    We began including Medicare and all DRG payers after hiring additional staff. Texas Medicaid recently went to APR-DRGs so we will be learning that system once we get the grouper and training.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    Sharon.cole@phn-waco.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We have not yet because Medicaid is not *yet* a DRG payer. However, it is supposed to happen in the near future. It will also greatly increase our reviews. It is my understanding that approx 30% of our patients are Medicaid. We are hoping to double our CDI team to expand to all payers and hopefully we can add staff and get them trained prior to this change.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    In California, Medi-Cal will begin to reimburse us using APR-DRG methodology with an implementation date of July 1, 2013.

    This may add a layer of complexity to our reviews given the nature of the logic structure for the APR-DRG methodology is different than that for CMSs MS-DRG structure, and, in my opinion, more complicated.

    I imagine the claims will be reported on a separate Remittance Advice form from CMS (Medicare) - I am not certain of that and Finance has not yet stated. The payment will use APR-DRG system and weights that will be multiplied by a Facility Base Rate.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • paxnerospaxneros
    Was there an increase to your reviews? Any "differences" in queries - or in recovery auditing reviews? Florida has a large M'Caid population.

    Norma T. Brunson, RHIA,CDIP,CCDS
  • paxnerospaxneros
    I *fear* (job security!!!) this will be next!

    NTB
  • sabullocksabullock
    edited May 2016
    We added all patient review 2 years ago. Our state (MS) began paying by APR-DRG on 10/1/2012.
    I would suggest implement now so physicians will be accustomed to your queries. This especially important if you have a Pediatric population and the Peds docs have not been accustomed to CDI.
    Shelia Bullock
    Univ. of MS Med Ctr
  • teresa.russoteresa.russo
    edited May 2016
    We added Medicaid in August of this year.

    Thanks, Teresa

    Teresa Russo RN,CCM
    Documentation Improvement Coordinator
    Phone: (210)358-8608
    Fax: (210)358-0622
    University Health System, San Antonio-Texas
  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    We reviewed Medicaid concurrently in the past for approximately a year. The ROI was minimal. Our Medicaid plan bills with APR DRGs.
    We do post discharge queries when needed for this payor.

    Deborah A Dallen,RN, CCDS
    Albert Einstein Medical Center
    Phila PA 19141
    Clinical Documentation Coordinator
    Health Information Management
    215-456-8902
  • afloydafloyd
    I agree with Shelia. We are also in MS and began reviewing Medicaid upon the implementation of APR-DRG's on 10/1/12. This DRG payment system is SOI based. We had to look at things a little differently and be aware of what raised SOI more so than with MS-DRG's but so far, so good.

    April Floyd, RN, CCDS
    Director of CDCI
    Anderson RMC
  • teresa.russoteresa.russo
    edited May 2016
    Yes. There was a big increase...I apologize that I don't have those figures yet...as we are waiting on reports from 3M that will include Medicaid in our numbers.
    We have a large Medicaid population as well, however at our facility we do not review pediatric or normal mother/newborns. At about the same time we added in Medicaid population, we increased our CDI team with 4 new members.
    As far as differences in queries, I have not seen any difference as to content, but have increased our number of queries. RAC has not been involved here yet.

    Thanks, Teresa

    Teresa Russo RN,CCM
    Documentation Improvement Coordinator
    Phone: (210)358-8608
    Fax: (210)358-0622
    University Health System- San Antonio, Texas
Sign In or Register to comment.