Acute Care Hospitals will be subject to changes in their reimbursement methodology effective July 1, 2021. Acute Care Hospitals will be reimbursed using 3MTM All Patient Refined DRG (APR DRG) Software. This change does not affect in-state Critical Access hospitals, State-owned hospitals, and Institutions for Mental Disease. More information related to this update can be found here under ‘Hospital Prospective Payment System: DRG’.
As part of this update, concurrent and continued stay review authorization requirements will no longer be required for providers subject to DRG reimbursement. The concurrent and continued stay reviews will be replaced with retrospective DRG audits starting July 1, 2021.
Providers with existing fourth day review authorizations initiated before June 28, 2021 should continue to work with Telligen to receive ongoing authorizations for those affected stays to ensure proper claims processing and payment.