Date: March 19, 2019
To: Enrolled Hospitals: Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers
Re: Hospital Outpatient Acute Care Rate and Outpatient Calculator Updates
Per the requirements in Public Act 100-1181, hospital outpatient acute care rates have been updated. The effective date of the updated rates is dependent upon the type of hospital.
Critical Access Hospitals
The updated rates for Critical Access Hospitals only are effective retroactively to dates of service beginning July 1, 2018. Retroactive adjustments will be made for claims with dates of service between July 1, 2018 and March 7, 2019 that have been processed for payment under the previously posted rates. HFS will process adjustments to fee-for-service claims and HealthChoice Illinois managed care plans will be responsible for adjustments to claims for individuals covered by those plans.
Non-Critical Access Hospitals
The updated outpatient rates for hospitals that are not Critical Access Hospitals are effective for dates of service beginning March 8, 2019. There will be no retroactive adjustments for claims with dates of service prior to March 8, 2019.
The new calculator should be used for estimating pricing for Critical Access Hospital claims with dates of service beginning July 1, 2018 and for Non-Critical Access Hospital claims with dates of service beginning March 8, 2019. The previous version, Outpatient Calculator Effective July 1, 2018, should be used for Non-Critical Access Hospital claims with dates of service July 1, 2018 through March 7, 2019.
Questions regarding this notice may be directed to the Bureau of Rate Development and Analysis at 217-785-0710.
Dan Jenkins, Chief
Bureau of Rate Development and Analysis