KMAP BULLETIN: Hospital Inpatient DRG Outlier Payments Increase

Date: 09/27/18

KMAP HOSPITAL BULLETIN 18190 (PDF)

Effective with the processing date of September 11, 2018, and retroactive to dates of discharge on and after July 1, 2018, the inpatient DRG outlier payments for hospitals is increased to 78% for the cost outlier and day outlier.

The Hospital DRG Weights and Limits link has been updated on the Provider page of the Kansas Medical Assistance Program (KMAP) website.

Note: The effective date of the policy is July 1, 2018. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.

For the changes resulting from this provider bulletin, view the updated Hospital Fee-for-Service Provider Manual, DRG Weights and Rates section.