ACUTE CARE HOSPITAL

Medicare is a federal health insurance program for senior citizens and people with permanent disabilities.

Inpatient hospital care is covered under Medicare Part A and largely paid either on the basis of the inpatient hospital prospective payment system (IHPPS) or under a Medicare Advantage managed care contract. Beneficiary IHPPS cost-sharing is linked to a spell-of-illness deductible amount. A new spell-of-illness benefit period is established after a patient has been discharged from a hospital or skilled nursing facility for more than 60 days. Inpatient cost-sharing in 2008 is equal to:

• A $1,024 deductible for inpatient days 1-60
• A per-day $256 deductible for inpatient days 61-90
• A per-day $512 deductible for inpatient days 91-150, should the beneficiary decide to draw upon his/her 60, irreplaceable Lifetime Reserve Days.
• A per-day deductible of $128 for days 21-100 of a covered benefit period in a skilled nursing facility

NEWS

5/09/2008:: CMS today published the  final rule for the 2009 Long-Term Care Hospital (LTCH) PPS. A CMS fact sheet with details is also available and the final rule is expected to be published in the Federal Register May 9. Starting in FFY 2010, CMS will line the LTCH PPS with the normal acute care hospital PPS, so this rule will stay in effect for 15 months, starting July 1.  LTCH standard federal rates go up 2.7% in 2009, which includes a reduction to the market basket inflationary update to account for coding creep in 2008. The final rule also includes changes to the outlier threshold and area wage index.

4/29/2008:: A detailed analysis by the American Hospital Association and another by Lawrence Goldberg with Grant Thornton on CMS's FFY 2009 inpatient hospital prospective payment system proposed rule are available.  CMS predicts an overall 3% update to payment rates with reductions to the increase to account for coding creep and additional reductions to hospitals that do not submit quality data, including a proposed 43 new quality measures. The rule also proposes to update the calculation of the IHPPS area wage index calculation and adds nine "hospital-acquired conditions." DRGs with the largest shift in weights. Comments are due June 13.

12/18/2007:: CMS releases facts sheets on Medicare inpatient hospital PPS Hospital-Acquired Conditions and Present-on-Admission Indicators, including lists of affected hospitals and conditions, an implementation timeline and coding requirements.

12/10/2007  :: CMS and 3M release the FFY 2008 version of the Medicare Code Editor used to detect possible coding errors in Medicare bills. The manual release has a revised list of national edits and their corresponding ICD.9.CM codes.

11/27/2007 :: CY 2008 Medicare interim final rule on Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System published. Summary available to OHA members only.

11/26/2007  :: CMS releases timetable for development of the FFY 2009 Medicare Prospective Payment System hospital area wage index.

11/07/2007 :: CMS launches Web site devoted to managing the new requirements on Hospital-Acquired Conditions (HAC) and the reporting of Present-on-Admission (POA) indicators. The page has information on the HAC regulations, and POA coding and reporting.  

10/18/2007 :: Additional Corrections to 2008 Medicare Inpatient Hospital Prospective Payment System released in Manual Transmittal 1354.

10/10/2007 :: Corrections to 2008 Medicare Inpatient Hospital Prospective Payment System final rule out. Summary and state impact analysis available to members only.