April 24, 1990
Circular Letter No. 6 (1990)
TO: AUTOMOBILE SELF-INSURERS AND INSURERS LICENSED TO WRITE AUTOMOBILE INSURANCE IN NEW YORK
RE: REIMBURSEMENT FOR HOSPITAL INPATIENT SERVICES UNDER NO-FAULT FOR TREATMENT RENDERED ON AND AFTER JANUARY 1, 1988
Pursuant to Regulation No. 83 11 NYCRR 68.2, the no-fault rate schedules for reimbursing inpatient, hospital services provided under § 5102(a)(1) of the Insurance Law shall be in conformity with Section 2807-c of the Public Health Law.
This Circular Letter provides updated information to enable no-fault insurers to process and pay 1988. 1989, and 1990 hospital inpatient claims under the Diagnosis-Related Group (DRG) system. This data was prepared by the Department of Health's Office of Health Systems Management (OHSM) and includes the following:
$1. 1990 DRG Case Payment Rates for reimbursement of Acute and Alternate Level of Care Hospitalizations;
2. Revision of 1988 DRG data as it pertains to Service. Intensity Weight (SIW), Length of Stay (LOS) and Trim Points;
3. Adjustments for Acute Care Case Payment Rates for five hospitals for 1988;
4. Adjustments for Alternate Level of Care Case Payment Reimbursement Rates for eleven hospitals for 1988 and 1989.
Upon receipt of a written request from the senior claims officer of: your company, the Insurance Department will furnish one copy of this data to your company. Since this data has, been provided to workers" compensation insurers, please request it only if you have not previously received it from another source. You should make this information available to all your claims personnel who are responsible for the review of hospital inpatient billings payable under the no-fault law.
All necessary information for the calculation of 1990 hospitalizations is included with the data and will enable your claims personnel to make appropriate and timely DRG payments. Hospitals may also submit adjusted billings for 1988 and 1989 hospitalizations based upon the revised data received from OHSM.
Requests for the foregoing data and any questions or problems in connection with DRG implementation involving no-fault insurers should be brought to the attention of Ed McGuiness (212) 602-0334, Senior Examiner, in the Department's Property and Casualty Insurance Bureau, at the above address.
Very truly yours,
TWENDY E. COOPER
Acting Superintendent of Insurance