reimbursement@wiki

A hospital inpatient, for Medicare purposes, is defined in section 210 of the Medicare Hospital Manual as a person admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services.

CMS Fact Sheet:  Acute IPPS

Medicare Manuals

• Inpatient Hospital Services
• Duration of Covered Inpatient Services

Medicare Severity Diagnosis-Related Groups (MS-DRGs)

• 2008
• • List of MS-DRGs, Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay
  • Complications and Comorbidities (CC) –   Table 6J – CC List
  • Major Complications and Comorbidities (MCC) – Table 6I – MCC List
  • CC Exclusions –  Total CC Exclusion List, Table 6G - Additions to the CC Exclusions List, and Table 6H - Deletions from the CC Exclusions List
  • Crosswalk from CMS DRGs to MS-DRGs 

Reimbursement

• Hospital Pricing: A Regulatory Perspective by Deloitte (September 2006)
• Hospital Reimbursement Guide for Cypher drug-eluting stent (2003)

New Technology Add-On Payment

• IPPS New Technology Homepage -- http://www.cms.hhs.gov/AcuteInpatientPPS/08_newtech.asp

• • Establishment of New Tech and New Services Add-On Payment policy (7 Sept 2001) - 66 Fed Reg 46902-46925

  • • Criteria for "substantial clinical improvement": 66 Fed Reg 46913-46914.

  • A complete reading on Add-On Payments for New Services and Technologies is in the 2008 IPPS final rule published on August 22, 2007 - [CMS | Plain text | Fed Reg]

• (uploaded) Powerpoint Overview of the Medicare Inpatient Prospective Payment System New Technology Add-on Payment Provision, February 20, 2007

• • FY 2009 Application for New Medical Services and Technologies Seeking to Qualify for Add-On Payments Under the HIPPS

  • FY 2010 Application

     

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