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Provider Notice issued 03/28/08
For DRG-reimbursed hospital services with admissions on and after January 1, 2008, the Specific Fixed Loss Threshold used in the cost outlier payment calculation will be multiplied by 1.64. The DRG Payment Calculation Worksheet in Appendix H-22f, [Page 4], of the Handbook for Hospitals has been updated to reflect the new multiplier.
For per diem-reimbursed hospital services with admissions on and after January 1, 2008, a marginal cost payment factor of 0.17 will be used in the outlier payment calculation. The outlier payment calculation worksheet for per diem-reimbursed hospitals in Appendix H-22f, [Pages 4a and 4b], of the Handbook for Hospitals has been updated to reflect the new factor.
Changes to Cost Outlier Payment Calculation
| To: |
Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers |
| Date: | March 28, 2008 |
| Re: | Changes to Cost Outlier Payment Calculation |
PROVIDER BULLETIN - Update H200-08-01
The purpose of this bulletin is to advise hospitals of changes in the cost outlier payment calculation, and new policy regarding outlier payments to children’s hospitals.
Cost Outlier Payment Calculation
As a result of recent emergency amendments to 89 Ill. Admin. Code Section 152, the cost outlier payment calculation for admissions occurring on and after January 1, 2008, will change. An explanation of how the change impacts hospitals reimbursed by DRG and per diem reimbursement methodologies is provided below.
Children’s Hospitals
As a result of a recent emergency amendment to 89 Illinois Administrative Code Section 148.130, children’s hospitals, as defined in 89 Illinois Administrative Code Section 149.50(c)(A), are now eligible to receive outliers on claims for children through the age of 18.
Implementation
The department is currently in the process of programming the above outlier changes. After the new programming is implemented, the department will determine what claim adjustments are necessary, and adjust any affected paid claims containing admission dates beginning January 1, 2008, up to the implementation date.
The revisions in the replacement pages are identified by an “=” to the left of the affected text. Paper copies of the revised pages may be obtained by written request. To ensure delivery, you must specify a physical street address when requesting a paper copy.
You may submit your written request to the address below, or fax or e-mail it as noted:
Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax Number: (217) 557-8800 / E-Mail Address: hfs.ppu@illinois.gov
Providers wishing to receive e-mail notification, when new provider information has been posted by the department, may register at the following HFS Web site:
http://www.hfs.illinois.gov/provrel
Electronic claim submission via the Internet is available by registering on the department’s Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System at:
http://www.myhfs.illinois.gov/
The MEDI/IEC System is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, you will be given access to specific claim formats based upon your enrollment status with the department.
Instructions for updating the Handbook for Hospitals:
Remove appendix Page H-22f (4) dated July 2006 and replace with the updated Page (4) dated January 2008.
Remove appendix Pages H-22f (4a) and (4b) dated July 2006 and replace with the updated Pages (4a) and (4b) dated January 2008.