Florida: Medicaid EAPG calculator 2017

Published by Navigant Healthcare

Effective July 1, 2017, the Agency for Health Care Administration (AHCA) will implement a new ambulatory surgical center (ASC) and hospital outpatient reimbursement methodology utilizing the 3M Enhanced Ambulatory Patient Grouping (EAPG) for Florida Medicaid. This week, AHCA released updated information on the EAPG implementation, including individual hospital base rates and EAPG calculator. The rates vary due to the legislative direction that placed a 5 percent loss/gain corridor on the percentage increase or decrease. The spreadsheet calculates the allowed amount for a single claim on a single outpatient visit using a limited number of required data elements. Key data elements include the EAPG codes and EAPG grouping indicators for each claim detail line; these values must be determined outside of this Calculator using software from 3M Health Information Systems.

Publication Date: 2017

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