PART 2.3 - DIAGNOSIS-RELATED-GROUP PAYMENT METHODS AND POLICIES (296-23A-0400 to 296-23A-0580)

  1. 296-23A-0400 - What is a "diagnosis-related-group" payment system?
  2. 296-23A-0410 - How does the department calculate diagnosis-related-group (DRG) relative weights?
  3. 296-23A-0420 - How does the department determine the base price for hospital services paid using per case rates?
  4. 296-23A-0430 - How does the department calculate a hospital specific case-mix adjusted average cost per case?
  5. 296-23A-0440 - How does the department calculate the base price for DRG hospitals, except major teaching hospitals?
  6. 296-23A-0450 - What cases does the department exclude from base price calculations?
  7. 296-23A-0460 - How does the department calculate the diagnosis-related-group (DRG) per case payment rate for a particular hospital?
  8. 296-23A-0470 - Which exclusions and exceptions apply to diagnosis-related-group (DRG) payments for hospital services?
  9. 296-23A-0480 - Which hospitals does the department exclude from diagnosis-related-group (DRG) payments?
  10. 296-23A-0490 - Which hospital services does the department include in diagnosis-related-group (DRG) rates?
  11. 296-23A-0500 - When does a case qualify for high outlier status?
  12. 296-23A-0520 - How does the department pay for high outlier cases?
  13. 296-23A-0530 - How does a case qualify for low outlier status?
  14. 296-23A-0540 - How does the department pay for low outlier cases?
  15. 296-23A-0550 - Under what circumstances will the department pay for interim bills?
  16. 296-23A-0560 - How does the department define and pay for hospital readmissions?
  17. 296-23A-0570 - How does the department define a transfer case?
  18. 296-23A-0575 - How does the department pay a transferring hospital for a transfer case?
  19. 296-23A-0580 - How does the department pay the receiving hospital for a transfer case?

The following state regulations pages link to this page.