FLORIDA MEDICAID EAPG PRICING
FLORIDA MEDICAID EAPG PRICING
ENHANCED AMBULATORY PATIENT GROUPINGS
1 / ?2017 NAVCIGonAfNidTenCtiOalNaSnUdLPTrIoNpGrie, tIaNrCy . ALL RIGHTS RESERVED
Confidential and Proprietary
TOPICS
EAPG Grouping and Pricing
EAPG Payment Calculation
4 EAPG Scenarios o Bundling o Discounting o Bilateral / Terminated o Observation
EAPG Grouping Settings
Transition Support
E A
P G
2 / ?2017 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED
Confidential and Proprietary
EAPG GROUPING AND PRICING
3 / ?2017 NAVCIGonAfNidTenCtiOalNaSnUdLPTrIoNpGrie, tIaNrCy . ALL RIGHTS RESERVED
Confidential and Proprietary
WHAT IS EAPG?
EAPG stands for Enhanced Ambulatory Patient Grouping Developed by 3MTM Corporation Adopted by Florida Legislature on May 8, 2017 Payment method which classifies claim lines for outpatient visits
Assigns an EAPG Code to each line Determines a line price based on combination of:
o Diagnosis o EAPG Code (Classification of Visit) o Member Age / Gender o Provider / Location
Mandatory in Florida beginning July 1, 2017 for hospitals & ambulatory surgical centers
o Not applicable to free-standing labs, FQHCs, CHDs or transplant cases o Based on earliest First Date of Service (if on or after July 1st, 2017, use EAPG)
4 / ?2017 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED
Confidential and Proprietary
OUTPATIENT EAPG METHODOLOGY
EAPG Grouper Overview
EAPG grouper is an outpatient visit-based patient classification system designed by 3M
o EAPG grouper assigns an EAPG classification to each claim detail line o 564 different EAPGs under version 3.12
o Services within each EAPG have similar clinical characteristics and similar resource requirements
EAPG encompass the full range of ambulatory settings and outpatient services across the all-payer population
o EAPG classifications are available for all the outpatient services (including laboratory and therapies)
o EAPG classifications are available for all outpatient settings, including same day surgery units, hospital emergency rooms, and outpatient clinics
5 / ?2017 NAVIGANT CONSULTING, INC. ALL RIGHTS RESERVED
Confidential and Proprietary
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