Ariz. Admin. Code § R9-22-712.60 - Diagnosis Related Group Payments
A. Inpatient hospital services with discharge
dates on or after October 1, 2014, shall be reimbursed using the diagnosis
related group (DRG) payment methodology described in this section and sections
R9-22-712.61
through
R9-22-712.81.
B. Payments made using the DRG methodology
shall be the sole reimbursement to the hospital for all inpatient hospital
services and related supplies provided by the hospital. Services provided in
the emergency room, observation area, or other outpatient departments that are
directly followed by an inpatient admission to the same hospital are not
reimbursed separately. Are reimbursed through the DRG methodology and not
reimbursed separately.
C. Each
claim for an inpatient hospital stay shall be assigned a DRG code and a DRG
relative weight based on the All Patient Refined Diagnosis Related Group
(APR-DRG) classification system established by 3M Health Information Systems.
The applicable version of the APR-DRG classification system shall be available
on the agency's website.
D.
Payments for inpatient hospital services reimbursed using the DRG payment
methodology are subject to quick pay discounts and slow pay penalties under
A.R.S.
36-2904.
E. Payments for inpatient hospital services
reimbursed using the DRG payment methodology are subject to the Urban Hospital
Reimbursement Program under R9-22-718.
F. For purposes of this section and sections
R9-22-712.61 through R9-22-712.81:
1. "DRG
National Average length of stay" means the national arithmetic mean length of
stay published in the All Patient Refined Diagnosis Related Group (APR-DRG)
classification established by 3M Health Information Systems.
2. "Length of stay" means the total number of
calendar days of an inpatient stay beginning with the date of admission through
discharge, but not including the date of discharge (including the date of a
discharge to another hospital, i.e., a transfer) unless the member
expires.
3. "Medicare" means Title
XVIII of the Social Security Act,
42 U.S.C.
1395
et seq.
4. "Medicare labor share" means a hospital's
labor costs as a percentage of its total costs as determined by CMS for
purposes of the Medicare Inpatient Prospective Payment System.
Notes
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