Prospective Payment System

The fourth quarter 2008 hospital outpatient prospective payment system PRICER downloads have been posted on the CMS Web site. [PERL 200810-17]

This article outlines changes for inpatient hospital PPS for fiscal year 2009 and addresses changes to the Medicare severity-diagnosis related groups and ICD-9-CM coding that affects LTCH PPS, and IPF PPS. [MM6189]

The Centers for Medicare & Medicaid Services (CMS) has released the skilled nursing facility (SNF) prospective payment system (PPS) PC PRICER software for fiscal year (FY) 2009. [PERL 200810-06]

Changes to and billing instructions for various payment policies implemented in the October 2008 outpatient prospective payment system update. [MM6196]

The Social Security Act set a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (hospital insurance) based on prospectively set rates.

Here is an overview of the payment process for an inpatient psychiatric facility, also referred to as a TEFRA (Tax Equity and Fiscal Responsibility Act) facility.

An overview of the PPS for hospital outpatient services, some Part B services furnished to hospital inpatients who have no Part A coverage, and hospitalization services furnished by community mental health centers.

An overview of how payment is made for skilled nursing facility (SNF) services.

The integrated outpatient code editor provides instructions and specifications for processing claims for hospital outpatient departments under the OPPS and non-OPPS, community mental health centers, and for all non-OPPS providers. [MM6186]

A new IRF prospective payment system PRICER software package will be released prior to October 1, 2008, containing the updated rates effective for claims with discharge dates within October 1, 2008, through September 30, 2009. [MM6166]

Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary.

An overview of the PPS for inpatient rehabilitation hospitals and rehabilitation units - referred to as inpatient rehabilitation facilities (IRFs).

An overview for both the operating and capital-related costs of hospital inpatient stays in long-term care hospitals (LTCHs) under Medicare Part A based on prospectively set rates.

The latest versions of the inpatient psychiatric facility prospective payment system PC PRICER, and the skilled nursing facility prospective payment system PC PRICER have been updated and posted to the CMS Web site. [PERL 200808-21]

The Inpatient Psychiatric Facility Prospective Payment System Fact Sheet (revised May 2008) fact sheet is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. [PERL 200808-01]

The Outpatient Prospective Payment System (OPPS) Pricer Web page has recently been updated to include the July 2008 Provider Specific File. [PERL 200807-30]

Revised to reflect a legislative change that continues the cost-to-charge payment methodology for Brachytherapy and Therapeutic Radiopharmaceuticals. [MM6080]

The Fact Sheet, which provides general information about the IPF PPS, how payment rates are set, and...[CMS PERL Message 200612-04]