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).
- Prospective payments: (a) MSDRG operating payment & (b) MSDRG capital payment (detail below for both (a) & (b));
- 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.