November 1st Payment Methodology Update

According to the Department of Medical Assistance Services (DMAS), the Medicaid Memo outlining billing procedures for the November 1st rate update will be posted today, September 26th (as of writing this article, the memo was not yet online).  As providers know, beginning for dates of service November 1st forward, claims will be reimbursed on an individual RUGs basis, as opposed to the facility case mix.  As such, the rates in effect currently expire October 31st, with new rates in effect beginning November 1st. Providers can access November 1st rates here.

These rates represent a case mix neutral base rate.  The direct care portion of this base rate will be multiplied by the assigned RUGs weight on an individual’s claim.  The RUGs weights in effect November 1st can also be downloaded here

Providers need to double check their November 1st rates from the previously published rates, as a slight revision was made to correct an error in the calculation of the indirect cost day-weighted medians for three of the five indirect peer groups.