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You are Here: Home Page > Hospitals in New York State > All Patient Refined Diagnosis Related Groups (APR-DRGs)  

All Patient Refined Diagnosis Related Groups (APR-DRGs)

Hospital Inpatient Reimbursement Rate Reform Effective December 1, 2009

Effective December 1, 2009 the Department has been authorized by state statute to implement a new hospital inpatient payment system. To provide a more equitable and fair payment method for services being rendered, New York will be implementing a severity-based methodology using 3M ™ All Patient Refined Diagnosis Related Groups (APR-DRGs). In addition, a new acute care payment methodology has been developed.

The information provided on this page will provide details regarding implementation, weights and additional web resources pertaining to the APR grouper. Questions related to the new payment system can be directed to the Bureau of HCRA Operations and Financial Analysis electronic mailbox bhofamail@health.state.ny.us or via phone at 518-473-8822.

Presentations

• July 2009 - Health Care Reimbursement Reform MMC Plan and Commercial Payor Presentation (PDF, 3.0 MB, 39 pg.)
• July 2009 - Health Care Reimbursement Reform Vendor Presentation (PDF, 4.68 MB, 32 pg.)
• July 2009 - Health Care Reimbursement Regional Hospital Presentations (PDF, 2.4 MB, 65 pg.)

APR-DRG Weights & ALOS

• Final APR-DRG Weights Effective December 1, 2009

Outlier Thresholds

• Final Cost Outlier Thresholds effective December 1, 2009 - December 31, 2009 and January 1, 2010 - December 31, 2010

Notices

• CMS Approval of Hospital Inpatient Reform Implementation December 2009 Inpatient Rates

Rate Schedules

Questions related to the rate schedules can be directed to the Bureau of Primary and Acute Care Reimbursement electronic mailbox: bpacr@health.state.ny.us.

• APR-DRG and Exempt Rates for Medicaid Fee-for-Service effective 12/01/2009
• APR-DRG and Exempt Rates for Medicaid Managed Care effective 12/01/2009
• APR-DRG and Exempt Rates for Worker's Compensation/No-Fault effective 12/01/2009
• Payment Calculation Worksheets

Questions and Answers

• A list of frequently asked questions and answers have been developed to assist with the APR-DRGs. If you have additional questions, please email them to: bhofamail@health.state.ny.us or via phone at 518-473-8822.

3M ™ and New York State Initiatives

You can learn more about 3M ™ All Patient Refined Diagnosis Related Groups(APR-DRGs), background information, and resource material, by visiting the 3M ™ website at: 3M ™ Solutions.