FFY 2012 IPPS Proposed Rule Would Eliminate Hospice Data from IME and DSH Calculations, Modify the ESRD Add-On Payment Calculation

more+
less-

Under the Inpatient Prospective Payment System (IPPS) Proposed Rule for federal fiscal year (FFY) 2012, hospitals that serve a disproportionate share of Medicaid or end-stage renal disease (ESRD) patients would see changes to their payment adjustments. Hospitals that treat a large number of hospice patients on an inpatient basis will be particularly interested in proposed changes to the indirect medical education (IME) and disproportionate share hospital (DSH) adjustments. Hospitals that qualify for the add-on payment for hospitals with at least 10% ESRD discharges would also be affected by the proposed rule.

Hospitals that receive an IME or DSH adjustment should take note of the proposed change to rules for calculating those adjustments, which may be viewed here (see alert below for link). CMS has proposed to eliminate hospice beds from the IME calculation and hospice days from the DSH calculation. Hospice days would be removed from both the numerator and denominator of the Medicare and Medicaid fractions. In proposing to remove this hospice data, CMS notes that hospice care is not reimbursed under the IPPS, and that the level of care given to hospice patients is generally not on par with acute inpatient care. CMS argues that hospice days are comparable to observation and swing bed days, which were removed from the DSH adjustment in the FFY 2005 IPPS Final Rule. CMS has proposed an exception for IPPS-level acute care hospital services to a hospice patient for which it would receive payment under IPPS, such as treatment for a broken bone that is unrelated to the terminal illness.

Please see full alert below for more information.

LOADING PDF: If there are any problems, click here to download the file.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Ober|Kaler | Attorney Advertising

Written by:

more+
less-

Ober|Kaler on:

JD Supra Readers' Choice 2016 Awards
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
×
Loading...
×
×