PPS (Prospective payment system)
The Centers for Medicare & Medicaid Services (CMS) recently released reimbursement and policy changes for the 2018 home health care prospective payment system. [MM10310]
Change request (CR) 10175 provides instructions for payment to rural health clinics (RHCs) billing under the all-inclusive rate, and federally qualified health centers (FQHCs) billing under the prospective payment system, for care coordination services for dates of service on or after January 1, 2018. This article was revised November 13 to correct statements on page 2 (in bold). All other information is unchanged. [MM10175]
The Social Security Act set a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (hospital insurance) based on prospectively set rates.
Implementation of changes in the ESRD PPS and payment for dialysis furnished for AKI in ESRD facilities for 2018
Change request (CR) 10312 implements the 2018 rate updates for the end-stage renal disease prospective payment system (ESRD PPS) and payment for dialysis furnished for acute kidney injury (AKI) in ESRD facilities for 2018. [MM10312]
Change request (CR) 10273 implements policy changes for fiscal year (FY) 2018 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS, which unless otherwise noted, are effective for hospital discharges occurring on or after October 1, 2017, through September 30, 2018. This article was revised October 18 to reflect a revised CR 10273 issued October 17. The CR was revised to update the factor 3 denominator for hospitals treated as new, the fixed-loss amount for LTCH standard federal payment rate cases, reference to the grouper software version, applicable tables and files available, and to clarify the list of ICD-10 codes eligible for the GORE IBE device system new technology add-on payment. In addition, the assignment of the wage index for Indian health service or tribal hospitals of the pricer was updated in the attachment to the CR. [MM10273]
Due to revised rates in the fiscal year (FY) 2018 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS final rule correction notice, all IPPS and LTCH PPS claims with discharge dates on or after October 1 through October 23 are being held until the revised pricers are tested and installed.
An overview of the PPS for hospital outpatient services, some Part B services furnished to hospital inpatients who have no Part A coverage, and hospitalization services furnished by community mental health centers.
An overview for both the operating and capital-related costs of hospital inpatient stays in long-term care hospitals (LTCHs) under Medicare Part A based on prospectively set rates.
An overview of the PPS for inpatient rehabilitation hospitals and rehabilitation units -- referred to as inpatient rehabilitation facilities (IRFs).
Here is an overview of the payment process for an inpatient psychiatric facility, also referred to as a TEFRA (Tax Equity and Fiscal Responsibility Act) facility.
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