IPPS Payment Update - Summary
• Back to Basics
• MS-DRG Relative Weights
• MS-DRG Coding Changes
• Transplant DRGs
• Emergency Medical Treatment and Active Labor Act
• Coding and Documentation Off-set
• Reporting Hospital Quality Data for Annual Hospital Payment Update (RHQDAPU)
IPPS Payment Update - Summary
• Quality Measures
- New Quality Measures
• Hospital Acquired Conditions
• Wage Data, Wage Index and Labor Related Share
• Geographic Reclassification Criteria
• Disproportionate Share Hospital Payments
• New Medical Residency
– IME
– DGME
IPPS Payment Update – Summary
• Rural Floor Budget Neutrality Adjustment
• Outlier Payments
Back to Basics
• DRG Payment is made up of:
– Fixed amount X DRG Weight + Add-ons
• Labor related share adjusted by the wage index of
geographic location
• Non-labor related share (adjusted by cost of living if in
Hawaii or Alaska)
– Add-ons
• Disproportionate Share (DSH)
• Approved teaching hospital (IME)
• New technology/medical service
• Capital payment
IPPS – Medicare Severity DRGs
• Initiated in 2008 as a means to recognize the
differences in DRGs based on “severity”
• Increased number of DRGs from 538 to 746.
• Instead of two levels of severity, MS-DRG has 3
– With Major CC – Specific to MS DRG
– With CC } Old DRG
– Without CC } Old DRG
• Phased in implementation with a 2 year period
• FFY 2010 left MS-DRG weights unchanged
• Changes reflect changes in ICD-9-CM coding.
2010 MS DRG Coding Changes
• MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue): Infected Hip and Knee Replacements (Codes 80.05, 80.06, 84.56)
Cardiac Rhythm Management
• The weighted financial impact for CRM procedures
was higher than last year.
• ICD and CRT-D payment rates increase by 1.25%.
• Pacemaker and CRT-P rates increase by 0.5%.
• ICD and CRT-D replacements...