APR-DRG Weights and ALOS for Acute Services

January 1, 2016 Inpatient Rate Update

The APR-DRG weights effective January 1, 2016 will not be updated. For discharges beginning on or after January 1, 2016, the SIWs, cost thresholds and ALOS effective July 1, 2014 will be used for payment purposes with the updated APR-DRG grouper version 33. Please refer to "Final APR-DRG Weights effective July 1, 2014 (version 31)" for the weights utilized effective January 1, 2016.

In addition, since the grouping is developed by 3M using clinical logic, if a claim does not group to an APR-DRG as the provider expects it to group, the provider will need to contact 3M to discuss the grouping logic. If 3M does determine, based on their clinical review, that the grouping should be revised, the Department is requesting the provider submit an email to hospffsunit@health.ny.gov informing the Department about the grouping logic discussion with 3M and the outcome for informational purposes.