Similarities and Differences MaineCare vs. Medicare DRGs

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• To the Future APCs • 19
MaineCare APCs • • Ambulatory Payment Classifications (APC) – Classification of outpatient services clinically similar; for use in determining facility reimbursement as defined in the Medicare APC system • MaineCare outpatient claims are paid via PIP and adjudicated for reporting on remittance under APCs • State planning with anticipation of approval for a 7/1/12 implementation • 20
Page 1 and 2: • Similarities and Differences Ma
Page 3 and 4: • Effective 7/1/2011 Effective da
Page 5 and 6: Fundamentals • • Assuming Maine
Page 7 and 8: Fundamentals • • Hospitals repo
Page 9 and 10: MaineCare vs. Medicare • Comparis
Page 11 and 12: Hospital Acquired Conditions •
Page 13 and 14: Hospital Discharge and Transfers
Page 15 and 16: Post Acute Care Transfers • • M
Page 17 and 18: The 72-Hour Rules • • Medicare
Page 19: Differences and Unknowns • • Me
Page 23 and 24: MaineCare APCs • • The MaineCar
Page 25 and 26: MaineCare APCs • • MaineCare is

Similarities and Differences MaineCare vs. Medicare DRGs

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