Ch. 3: Medicare Payments (p. 48) Flashcards

1
Q

Hospital Inpatient Payment

A

Medicare pays hospitals for IP care on a bundled services unit basis: prospective payment system (PPS).

  1. Prospective payments: (a) MSDRG operating payment & (b) MSDRG capital payment (detail below for both (a) & (b));
  2. Reasonable cost payments:
    Bad debts, organ acquisition, graduate medical education.

(a) DRG operating payment:
Base rate;
Adjustments for wage index, labor, non-labor, MSDRG weight;
Indirect medical education;
Disproportionate share;
Quality performance (HRRP, VBP, HAC);
Transfers;
Outliers;
New technology.

(b) MSDRG capital payment:
Base rate;
Adjustments for wage index, COLA, MSDRG weight;
Indirect medical education;
Disproportionate share;
Transfers;
Outliers.

Exceptions by statute:
Children’s hospitals;
Distinct psychiatric and rehabilitation units;
Hospitals outside the 50 states;
Hospitals in states with an approved waiver;
CAHs.

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