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September 13, 2011

Prospective Payment System

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Overview

Prospective Payment System

December 12, 2008

When the Medicare program for hospitals was authorized in 1965 it originally reflected the structure of the traditional indemnity insurance models that it was based on, and was also required to reimburse hospitals on a “reasonable cost” basis.

CHA News Article

CMS to Host IRF PPS Call

May 10, 2012 Patricia Blaisdell

The Centers for Medicare & Medicaid Services (CMS) will host a conference call May 31 from 11 a.m. to 12:30 p.m. (PT) on the coverage requirements for the inpatient rehabilitation facility (IRF) prospective payment system. The call will address coverage requirements for IRF admissions that went into effect Jan. 1, 2010. CMS personnel will present an overview of the requirements and answer questions from providers. To register for the call, go to www.eventsvc.com/blhtechnologies. Presentation materials will be posted at least one day in advance at www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html.

Regulatory Advisory

CMS Releases Proposed Rule for FFY 2013 IPPS and LTCH PPS

April 24, 2012 Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) issued its proposed rule today for rate updates and policy changes to the Medicare inpatient prospective payment system (IPPS) and long-term-care hospital (LTCH) PPS for federal fiscal year (FFY) 2013. According to CMS, the IPPS proposed rule would increase operating payments to general acute-care hospitals by .9 percent or $904 million in FFY 2013. CMS estimates the FFY 2013 IPPS market basket update at 3.0 percent. However, the Affordable Care Act requires an adjustment in FFY 2013 for productivity (negative 0.8), as well as a 0.1 decrease in the market basket. In addition, among other policy and payment changes, CMS proposes continued implementation of a documentation and coding adjustment of negative 2.7 to remove any remaining effect of documentation and coding that occurred in FFYs 2008, 2009 and 2010. CHA is disappointed that CMS has once again proposed an additional year of coding and documentation adjustments.

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