NCTracks
Medicaid Hospital Providers Implementation of January 1, 2015 DRG Base Statewide Median Hospital Rates and 2.1% Reduction DRG Weights
Centers for Medicare & Medicaid Services (CMS) approved N.C. State Plan Amendment (SPA) 14-046 with effective date January 1, 2015.
SPA 14-046 establishes all hospitals with diagnosis-related groups (DRG) base statewide median rate but excludes the University of North Carolina (UNC) hospitals and Vidant Medical Center (Pitt County). The Grouper 32 Weights are reduced by 2.1 percent from the October 1, 2014 weights. These updates will be included in the June 16, 2015 checkwrite for claims with discharge dates on or after June 10, 2015.
A copy of the DRG Grouper version 32 weights and thresholds is available in Excel format on the N.C. Division of Medical Assistance (DMA) Fee Schedules web page.
Claims will be reprocessed with discharge dates on January 1, 2015 through June 10, 2015.
Once a reprocessing date has been established, DMA will notify the hospitals in advance. No action is required by providers.