DRG Coding Advisor-PPS less controversial, more fulfilling
Proposal contains few surprises
Early November revealed another prospective payment system (PPS), this one much less controversial than the one for outpatient services.
On Nov. 2, the Health Care Financing Administration (HCFA) in Baltimore published on its Web site its proposed PPS for rehabilitation facilities. These facilities can be either freestanding or units of acute care hospitals. HCFA posted the proposal on the Federal Register Web site Nov. 3.1
Health care officials have found few surprises in the proposal, reports the American Hospital Association News. Here are some of the features of the system, which will be phased in over two years, as reviewed by the AHA.
• Rehab facilities will be paid on a per-discharge basis (for operational and capital costs).
• There will be comorbidity adjustments for varying degrees of patient needs.
• A transfer provision will determine payments for patients who are transferred to other facilities before treatment completion.
• Payments will be adjusted for geographic differences in wages and for disproportionate shares of low-income patents; rural facilities will receive special adjustments.
• Additional payment adjustments (coming from a set-aside fund made up of 3% of the overall rehab PPS budget) will be made for outlier cases.
• Facilities will use the Minimum Dataset Post Acute Coding assessment tool to determine each patient’s needs and appropriate payment categories.
The proposed rehab PPS is designed to pay 2% less than those under the existing cost-based system, but this percentage may change if Congress passes Balanced Budget Act relief legislation.
Reference
1. 65 Fed Reg 66,303 (Nov. 3, 2000).
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