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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/25/11

​To:  Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers

Date: July 25, 2011

Re: Change to Cost Outlier Payment Calculation Retroactive to January 1, 2011

As a result of recent amendments to 89 Ill. Admin. Code Section 152, the department has revised the cost outlier payment calculation for admissions occurring on and after January 1, 2011.

For DRG-reimbursed hospital services with admissions on and after January 1, 2011, the Specific Fixed Loss Threshold used in the cost outlier payment calculation will be multiplied
by 1.99.

 

The department implemented programming changes as of June 16, 2011, for the above outlier calculation. The department will determine what claim adjustments are necessary, and adjust any affected paid claims containing admission dates beginning January 1, 2011, up to the implementation date.

 

The Cost Outlier for DRG-Reimbursed Hospitals worksheet (fillable form HFSWEB 013 (pdf)) on the department's Web site will be updated to identify the new multiplier.

 

Any questions may be directed to your hospital's medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Theresa A. Eagleson, Administrator
Division of Medical Programs