| Fee Schedules |
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The IME Provider Fee Schedules are formatted for viewing on line or downloading. To view the Fee Schedule information for a particular Provider Type, scroll down to the specific Provider Type. Also available is a document that explains the factor codes and pricing modifiers found on the Fee Schedules.
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| PDL (Preferred Drug List) |
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The Preferred Drug List (PDL) was created in an effort to select both clinically sound and cost effective medications for use by the members of Iowa Medicaid.
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| SMAC (State Maximum Allowable Cost) |
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State Maximum Allowable Cost (SMAC) rate schedules are based on the premise that chemically equivalent drug products in the same strength, dosage, and package size available from multiple sources should be reimbursed similarly.
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| APG Weights |
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In July 1994, the Department implemented a prospective payment system � ambulatory patient groupings (APGs) � for reimbursement of outpatient hospital claims. Prior to that time, outpatient claims were reimbursed using a percentage of hospital charges, with a cost settlement provision.
Hospital base rates are developed using a blend of hospital-specific and statewide average costs taken from hospital cost reports. In addition, there are weights assigned to ambulatory patient groupings, which represent the relative value associated with the charge for conducting an outpatient procedure or medical visit, as compared to the charge of the average or mean procedure or visit. To view the previously available APG Weights effective 10/01/02, click here.
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| DRG Weights |
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Inpatient claims have been reimbursed using a prospective payment system � diagnosis-related groups � since 1987. Hospital base and capital cost rates are developed using a blend of hospital-specific and statewide average costs taken from hospital cost reports.
In addition, there are weights assigned to more than 500 diagnosis-related groups, which represent the relative resource consumption, as measured by the relative charges by hospitals for cases associated with each DRG. Iowa Medicaid uses the Medicare DRG system with Medicaid-specific weights calculated for each DRG. To view the previously available APG Weights effective 10/01/02, click here.
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| Nursing Home Rates |
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View updated Nursing Facility Rates.
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