Question
Please fill the following tables for the inpatient prospective payment systems:
IPPS Payment Process
IPFPPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)
Patient data that must be presented with the claim
Facility level adjustments
Patient level adjustments
High cost outlier payment process, if applicable (write a few sentences for the process)
Other adjustments, if any
IPPS Payment Process
IPFPPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)
Patient data that must be presented with the claim
Facility level adjustments
Patient level adjustments
High cost outlier payment process, if applicable (write a few sentences for the process)
Other adjustments, if any
Explanation / Answer
IPPS Payment Process IPFPPS Payment Process Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process) MS-DRG Assignment data determines payment. Establishing an initial payment rate, adding on for disproportionate share hospital, adding on for indirect medical education adding on for high cost outlier, and adding on for new medical service and technology that help determine the code and payment The base rate for each patient day in at and inpatient psychiatric facility is based on the national average daily routine operating, anciliary, and capital costs in IPFs.The base rate is then adjusted to account for patient and facility characterstics that can be obtained from administrative data Patient data that must be presented with the claim Patient Age, length of stay Patient Age, length of stay, diagnosis, comorbidies Facility level adjustments Labor Portion of Base Payment, Non-Labor Portion of Base Payment, Adjusted Base Rate, added IME and DSH payments to Adjusted Base Rate, Wage adjusted labor portion, Base rate adjusted For geographic Factors, high-cost outlier payment amount Wage index adjustment, Rural location adjustment, Teaching adjustment, Cost of living adjustment, Outlier payments, Emergency department adjustment