SB 853 (Statutes of 2010, Chapter 717) mandates that the California Department of Health Care Services (DHCS) develop a Diagnosis Related Group (DRG) Payment System by July 1, 2012. DHCS has hired ACS, a Xerox company, to lead the transition to the new payment system. In an effort to make the process transparent, DHCS asked CHA to create a consultation group of health care providers to give input on the development of the payment system. The group meets monthly to discuss DRG payment system policy and implications. This website area contains pertinent documents related to those discussions, and much of the information is available to members only. All member hospitals are advised to contact CHA with any additional questions, thoughts or concerns.
The next installment in the California Department of Health Care Services (DHCS) monthly webinar series to help providers transition to the All Patient Refined Diagnosis Related Group (APR-DRG) reimbursement is Thursday, Nov. 7 from 11 a.m. – 1 p.m. (PT), with an additional session to be held Dec. 5. The sessions will provide a general overview of the new methodology. Details on how to participate in the webinars and information on other DRG trainings are attached.
The California Department of Health Care Services (DHCS) has released guidance on how hospitals should bill under the Diagnosis Related Payment (DRG) methodology for beneficiaries hospitalized with a California Children’s Services (CCS)-eligible condition, as well as a condition covered by a Medi-Cal managed care plan (MCP). Effective retroactively to July 1, a specific billing policy will apply for services provided to Medi-Cal beneficiaries with CCS-eligible conditions who are enrolled in an MCP that does not cover CCS-eligible conditions.
The California Department of Health Care Services (DHCS) has published the attached list of what are expected to be the most common reasons for claim denials under the all patient refined diagnosis-related group (APR-DRG) methodology. On July 1, the APR-DRG reimbursement methodology became effective for private, inpatient general acute care hospitals. Other APR-DRG information, including bulletins and training updates, is available at www.dhcs.ca.gov/provgovpart/Pages/DRG.aspx.
Following approval by the Centers for Medicare & Medicaid Services in May allowing the implementation of the All Patient Refined Diagnosis Related Group (APR-DRG) reimbursement methodology, hospitals will need to finalize their preparation for the July 1 start of the new payment system. The California Department of Health Care Services (DHCS) has updated its DRG web page at www.dhcs.ca.gov/provgovpart/Pages/DRG.aspx with current information and bulletins including:
APR-DRG Reimbursement Implementation Official Notification
Most Common Denials Anticipated Under DRGs
New Medi-Cal Provider Manual pages for DRG billing instructions
In addition, DHCS will continue its APR-DRG monthly training series through September. Any questions related to DRG reimbursement, as well as requests to be added or removed from the DRG listserve, can be sent directly to DRG@dhcs.ca.gov.
A recording of the July 13 web seminar on the Medi-Cal diagnosis-related group data set and simulation is now available at http://tinyurl.com/86drjz6. The web seminar, hosted by the Department of Health Care Services, guides hospitals through the instructions for modifying their hospital-specific data file to reflect the final simulation results. For more information on the DRG transition, visit www.calhospital.org/medi-cal-drg-conversion.