WebOct 31, 2016 · Outpatient Hospital Payment Enhanced Ambulatory Patient Groups (EAPG) The Department of Health Care Policy & Financing (the Department) implemented the Enhanced Ambulatory Patient Grouping System for October 31, 2016. Enhanced Ambulatory Patient Groups (EAPG) weight tables are provided for reference by various … WebThe EAPG reimbursement methodology is utilized to group payment for similar significant procedures when billed on an outpatient hospital claim, such that only the most resource-intensive significant procedure will be …
Medicaid Outpatient Payment Policy - MACPAC
WebPayment Methodology: Outlier Cases 5. APR-DRG 225 Appendectomy Severity level 4 Extreme APR/SEV Weight 3.0654 Network Outlier Cost Threshold $21,256 Facility Rate … WebHospital Payment Policy Inpatient acute care hospital services are reimbursed on a prospective basis using the All Patient Refined Diagnosis Related Group (APR-DRG) … sample custody declaration for family court
Hospital Outpatient EAPG Billing and Payment Questions
WebAug 16, 2024 · Both hospital-based ambulatory surgery and emergency department services received 100% APG payment with the implementation of the APG reimbursement methodology. However, APG reimbursement for hospital outpatient departments, diagnostic and treatment centers and free-standing ambulatory surgery centers is … WebEffective July 1, 2024, reimbursement for claims with procedure codes 99281-99284 and a principal diagnosis code on the Preventable Emergency Room Diagnosis List shall be based on an all-inclusive EAPG payment weight for claims with CPT 99281 and a principal diagnosis code on the Preventable Emergency Room Listing. Webo Allows payment of additional medical visits/services ancillary EAPG • 50-Bilateral Procedure. o Flags a procedure for additional payment (150%) • 52 & 73-Terminated Procedure. o Flags a procedure for discounting (50%) • 59-Separate/distinct Procedure. o Allows separate payment of a significant procedure (turns off consolidation sample cub scout pack meeting agenda