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Welcome  » April 27, 2024 7:25 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Hospital, Inpatient
04/27/2024  

Reimbursement : Amounts

Topic #1381

Diagnosis Related Groups

Wisconsin Medicaid uses a payment system for enrolled in-state, out-of-state, and border-status hospitals based on DRGs. The DRG system covers the following:

  • Acute care general hospitals
  • IMD hospitals, except state-operated IMD hospitals
  • The following are excluded from the DRG system and are paid under a hospital-specific daily rate:

    • Rehabilitation hospitals
    • State-operated IMD hospitals
    • State-operated veteran's hospitals

    When provided in an inpatient hospital setting, professional and other services must be submitted on a professional claim by a separately certified provider. Certain services, or professionals providing them, are ineligible for reimbursement under the DRG payment system.

     
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