Work comp: PC Pricer tool for inpatient hospital bills
Minnesota Statutes § 176.1362 provides that the maximum payment for most workers' compensation inpatient hospital services is 200% of the amount calculated under the Medicare diagnosis-related group (DRG) system.
For discharges on or after Oct. 1, 2021, payment for inpatient services, articles and supplies must be calculated using the inpatient PPS Web Pricer available on Medicare's website. Instructions for using the inpatient PPS Web Pricer are available below.
For discharges prior to Oct. 1, 2021, payment must be calculated using the applicable PC Pricer program. Links to download the PC Pricer program and instructions about how to use the downloadable PC Pricer program are available below.
Medicare's inpatient PPS Web Pricer
PC Pricer download
For hospital discharge dates from Oct. 1, 2020, through Sept. 30, 2021: The INPC20C PC Pricer, effective May 20, 2020, must be used to calculate the amount payable. (This is the PC Pricer program most recently available on the Medicare website as of July 1, 2020.)
Download INPC20C PC Pricer (.zip file; 27MB)
For hospital discharge dates from Oct. 1, 2019, through Sept. 30, 2020: The FY 2019.0 PC Pricer, updated April 8, 2018, must be used to calculate the amount payable. (This is the PC Pricer program most recently available on the Medicare website as of July 1, 2019.)
Download FY 2019.0 PC Pricer (.zip file; 21MB)
Instructions for using the downloadable PC Pricer Program
The law directs payers to calculate the amount payable for inpatient hospital services using the PC Pricer program posted on the department’s website. However, because Medicare's payment year is from Oct. 1 through Sept. 30, the date of service must be adjusted to calculate payment using the applicable PC Pricer.
To calculate the amount payable using the PC Pricer program, make sure you are using the correct Pricer effective for the dates of service. When inputting the date of service, always enter the discharge as occurring one year prior to the date of service, with the same month and day portions of the dates of service.
For example, an inpatient bill with dates of service from Nov. 1 to 10, 2019, should be entered in the Pricer as Nov. 1 to 10, 2018, and an inpatient bill with dates of service from Feb. 3 to 7, 2020, should be entered in the Pricer as Feb. 3 to 7, 2019. The PC Pricer will then calculate the amount that would be paid by Medicare.
Additional information about inpatient hospital payments for Minnesota workers' compensation
Spreadsheet: Hospital provider identification numbers
Training: PC Pricer program
Hospital catastrophic injury threshold amounts
Discharges from Oct. 1, 2021, through Sept. 30, 2022: $253,752
Discharges from Oct. 1, 2020, through Sept. 30, 2021: $226,888
Discharges from Oct. 1, 2019, through Sept. 30, 2020: $209,868*
*The threshold amount listed here corrects the previous amount listed on Oct. 1, 2019. See details about the past corrections. If you have any questions about prior threshold amounts, contact the Department of Labor and Industry’s medical policy staff at 651-284-5052 or email@example.com.