title: Final inpatient rehabilitation PPS rule improves on proposed rule.
abstract: On August 7, 2001, the Centers for Medicare and Medicaid Services (CMS--formerly HCFA) released the final rule for a new prospective payment system (PPS) for inpatient rehabilitation services describing the process that must be used to receive payment for such services provided to Medicare beneficiaries. The process consists of five steps: First, a clinician performs assessments of the patient upon admission and at discharge. Second, the patient is classified into a case-mix group (CMG) with an assigned relative-value weight within that CMG. Third, the Federal prospective payment rate is determined by multiplying the relative-value weight by an annually updated, budget-neutral conversion factor. Fourth, the Federal prospective payment rate is adjusted to account for facility-specific factors. Finally, the facility-adjusted payment rate may be adjusted for case-specific factors. The final rule eliminates three deficiencies in the proposed rule by providing increased payment for treating any comorbidities documented prior to the second day before discharge, providing more appropriate payment for transfer cases, and minimizing the paperwork associated with patient assessment.
authors.affiliation: Health Law Practice Group, ShawPittman LLP, Washington, DC, USA. max.reynolds@shawpittman.com
authors.forename: M
authors.initials: M
authors.lastname: Reynolds
mesh_terms: D000368:Aged; D003953:Diagnosis-Related Groups; D005376:Financial Management / Q000331:legislation & jurisprudence*; D018574:Home Care Agencies / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D006278:Medicare / Q000331:legislation & jurisprudence*; D016311:Outliers, DRG; D011445:Prospective Payment System / Q000331:legislation & jurisprudence*; D012047:Rehabilitation Centers / Q000191:economics* / Q000331:legislation & jurisprudence; D012866:Skilled Nursing Facilities / Q000191:economics / Q000331:legislation & jurisprudence; D019467:Subacute Care / Q000145:classification* / Q000191:economics; D014481:United States