More Reimbursement Methodologies Available

Last week during the ICD10monitor’s IPPSpalooza, we reviewed changes to the Inpatient Prospective Payment System (IPPS). The updates to IPPS are effective Oct. 1, 2024.

There are other reimbursement methodologies that change October 1as well. For example, Inpatient Psychiatric Facility (IPF) and Long-Term Care Hospitals (LTCH).

The final rule for LTCH prospective payment system was released on Aug. 1, 2024. This methodology uses MS-LTC-DRGs. The LTCH standard payment rate will increase 3.0 percent. If the LTCH does not meet the reporting requirements of Long-Term Care Hospital Quality Reporting, there is a 2 percent reduction in the annual increase factor.

The final rule includes the adoption of four new assessment items in the Social Determinants of Health (SDOH) category to be collected by the LTCH Continuity Assessment Record and Evaluation Set (LCDS). The items include the following:

1. Living situation

2. Food (2 items)

3. Utility

The collection will occur at admission. The final rule made changes to Transportation SDOH item. There was also an extension to the admission assessment window from three days to four days beginning Oct. 1, 2026.

The Inpatient Psychiatric Facility final rule was issued on July 31. The payment rates were increased by 2.8 percent. The patient level adjustments include the following:

• MS-DRG assignment
• Selected co-morbidities
• Patient age
• Variable per diem

The electroconvulsive therapy (ECT) payment was increased from $385.58 to $661.52 in FY25.

The Centers for Medicare and Medicaid Services (CMS) is collecting public input on the IPF patient assessment instrument. The goal is to identify meaningful data elements for collection for acute inpatient psychiatric care setting.

The information will be used to develop an update to the Inpatient Psychiatric Facility patient assessment instrument (IPF-PAI).

One last item to include in this update. CMS released the MAC Implementation File 8 on Friday, Aug. 16. The importance of this file is that it provides a detail list of the New Technology Add-on Payments (NTAPs) for FY25 for Inpatient Prospective Payment System (IPPS).

FY25 is right around the corner!

Resources:

FY25 Long-Term Care Hospitals: https://www.cms.gov/medicare/payment/prospective-payment-systems/long-term-care-hospital

FY25 Inpatient Psychiatric Facilities: https://www.cms.gov/medicare/payment/prospective-payment-systems/inpatient-psychiatric-facility