Similarities and Differences MaineCare vs. Medicare DRGs

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DRG Base • • MaineCare’s DRG payment methodology includes 3 components – a statewide direct care rate • DRG base case mix specific; not cost settled • Unadjusted $4177.00 – a hospital specific estimated capital expense • cost settled – a medical education rate • cost settled • 3
Fundamentals • • Assuming MaineCare has adopted the same policies used by Medicare – The basis for payment is the classification system referred to as MS-DRGs – The MS-DRG (Medicare Severity) is a payment classification system which provides a means of relating types of patients a hospital treats (i.e., its case mix) to the cost incurred by the hospital • 4
Page 1 and 2: • Similarities and Differences Ma
Page 3: • Effective 7/1/2011 Effective da
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 and 20: Differences and Unknowns • • Me
Page 21 and 22: MaineCare APCs • • Ambulatory P
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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