skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]

PPS (Prospective payment system)

Modified: 11/14/2017
The Centers for Medicare & Medicaid Services (CMS) recently released reimbursement and policy changes for the 2018 home health care prospective payment system. [MM10310]
Modified: 11/14/2017
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]
Modified: 11/11/2017
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.
Modified: 11/7/2017
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]
Modified: 10/20/2017
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]
Modified: 10/3/2017
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.
Modified: 9/29/2017
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.
Modified: 9/29/2017
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.
Modified: 8/2/2017
An overview of the PPS for inpatient rehabilitation hospitals and rehabilitation units -- referred to as inpatient rehabilitation facilities (IRFs).
Modified: 7/14/2017
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.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.