Inpatient Prospective Payment System (IPPS)

News & Analysis as of

Final FY 2017 Inpatient Psychiatric Facilities Payment and Policies Rule, Payment Matters

On August 1, 2016, CMS published the FY 2017 Inpatient Psychiatric Facilities (IPF) Prospective Payment System (PPS) – Rate Update notice. Some of the key changes are highlighted below....more

CMS Re-proposes Ban on Per-Click Fees for Space and Equipment Leases under Stark

In the CY 2017 Medicare Physician Fee Schedule (CY 2017 MPFS), the Centers for Medicare & Medicaid Services (CMS) issued proposed updates to the physician self-referral law (Stark law). The primary Stark law update focused on...more

CMS Finalizes FY 2017 Update to Medicare IPPS, LTCH PPS Rates and Policies

The Centers for Medicare & Medicaid Services (CMS) has released its final rule to update Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS)...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

CMS Finalizes Medicare IRF PPS Update for FY 2017

On August 5, 2016, CMS is publishing its final rule to update Medicare prospective payment system (PPS) rates for inpatient rehabilitation facilities (IRFs) for FY 2017, which begins October 1, 2016. CMS estimates that...more

CMS Issues Pay Increase for Inpatient Psychiatric Facilities

On July 28, 2016, CMS issued a notice updating the prospective rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities. Beginning in fiscal year 2017, inpatient psychiatric facilities will...more

Two-Midnight Rule Update

Medicare and Medicaid Services (CMS) on August 19, 2013, the two-midnight rule provided that an inpatient admission generally would only be payable under Medicare Part A if: (1) the admitting practitioner had an expectation,...more

MedPAC Releases Comment Letters on Fiscal Year 2017 Inpatient Hospital, Hospice, Skilled Nursing, and Inpatient Rehabilitation...

In late May, the Medicare Payment Advisory Commission (MedPAC) issued comment letters in response to multiple CMS payment proposals in which MedPAC encouraged refinements to the hospital star rating system to emphasize...more

Congress Considers Broader Hospital Site-Neutral Payment Exceptions and Other Payments Changes

In Depth - The House Ways and Means Committee next week is expected to consider and approve the Helping Hospitals Improve Patient Care Act of 2016, legislation that would create broader exceptions under much maligned...more

FY 2017 IPPS Proposed Rule Results in Modest Increase for Hospitals

CMS recently issued a proposed rule updating fiscal year (FY) 2017 Medicare payment policies and rates under the Medicare inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment...more

CMS Proposes FY 2017 Update for Medicare IPPS, LTCH PPS Rates and Policies

CMS has published its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2017....more

CMS Issues Rule to Implement LTCH PPS Wound Care Discharge Payment Policy, Geographic Reclassification Changes

CMS has published an interim final rule with comment period to implement a recent statutory provision addressing Medicare payments to certain rural long-term care hospitals (LTCHs) for severe wound care discharges. By way of...more

CMS Proposes Update to Medicare IRF PPS Payments for FY 2017

CMS has published its proposed rule to update Medicare prospective payment system (PPS) rates for inpatient rehabilitation facilities (IRFs) for FY 2017, which begins October 1, 2016. CMS estimates that rates would increase...more

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

CMS Releases Hospital Inpatient PPS and Long-Term Care Hospital PPS Proposed Rule

CMS released updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) in a proposed rule on April 18, 2016 (Proposed Rule). The Proposed...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 21, 2016, CMS issued a proposed rule entitled, “Medicare Program: FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements.” This...more

CMS Proposes to Reverse 0.2 Percent IPPS Rate Reduction After Two-Midnight Rule Litigation Loss

In the FY 2017 IPPS Proposed Rule, CMS announced that it would reverse the 0.2 percent IPPS rate cut that was imposed in FY 2014 (and re-adopted in subsequent years) related to the Two Midnight Rule and increase the...more

In IPPS rule, CMS proposes changes for urban teaching hospitals with rural training track programs

On April 18, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2017 proposed rule updating the Inpatient Prospective Payment System (IPPS) and the Long Term Acute Care Hospital Prospective...more

CMS issues IPPS proposed rule, proposes to permanently remove -0.2 percent offset for Two Midnight Rule

On April 18, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2017 proposed rule updating the Inpatient Prospective Payment System (IPPS) and the Long Term Acute Care Hospital Prospective...more

Establishing a hospital's per resident amount: Be careful, as the result is permanent!

A teaching hospital's direct graduate medical education (DGME) payments are made on a per resident basis and are based on each hospital’s unique per resident amount (PRA). This PRA, once established, is permanent and cannot...more

Outliers: CMS Explains its Reasoning for FY2004 Fixed Loss Threshold Calculation

In accordance with the order issued by the D.C. Circuit in District Hospital Partners, LP v. Burwell and related cases, on January 22, CMS issued an explanation of the methodology it used to calculate the fixed-loss threshold...more

CMS Explanation of FY 2004 Outlier Fixed-Loss Threshold as Required by Court Rulings

On January 22, 2016, CMS published a rule providing additional explanation of certain methodological choices CMS made in establishing the fiscal year 2004 Medicare Inpatient Prospective Payment System fixed-loss threshold...more

CMS Issues Final Rule Implementing Mandatory Bundled Payment Program for Lower Extremity Joint Procedures

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule (Final Rule) that implements the Comprehensive Care for Joint Replacement model (CJR Model), a new bundled payment program covering certain...more

2-Midnight Rule Updates

- CMS Adopts Change to Benchmark and Shift in Enforcement - CMS Explains Reasoning Behind 0.2% Payment Reduction CMS has published discussions of the 2-midnight rule in two recent Federal Register publications. In the...more

The Medicare payment basics of becoming a new teaching hospital

Approximately 1,000 of the 5,000 hospitals in the United States that are paid under the inpatient prospective payment system (IPPS) are teaching hospitals that receive federal funding for graduate medical education (GME)...more

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