SoonerCare payment rates will change Jan. 1

Posted on: 12/20/17

The Oklahoma Health Care Authority (OHCA) will implement updated inpatient hospital payments for diagnosis related groups (DRGs) effective Jan. 1, 2018. This annual, revenue neutral process of re-basing and re-weighting DRG payments was delayed from Oct. 1.  

Along with the annual rebasing, OHCA will implement the current Medicare DRG Grouper (MS-DRG V35) this week, effective for discharges on or after Oct. 1, 2017.

OHCA provided more information on these changes in Provider Reimbursement Notice (PRN) 2017-09, on Dec. 19. The Notice also included:
  • The 2018 SHOPP assessment rate will be 3 percent of net hospital patient revenue.  OHCA mailed annual assessment notices to SHOPP hospitals on Dec. 14.
  • Rebased Ambulatory Payment Classification (APC) and Ambulatory Surgery Center (ASC) rates, effective Jan. 1, 2018, will be posted here.
  • The Disproportionate Share Hospital (DSH) audit report for 2014, conducted in 2017, will be posted here. The report identified some DSH overpayments that will be recouped from certain hospitals. 2013 and 2014 DSH recoupments will be reallocated to other DSH hospitals.
PRN 2017-09 is posted here(Rick Snyder)

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