Hospitals Have 2009 IPPS Final Rule

In the 2009 Inpatient Prospective Payment System (IPPS) final rule, released July 31 by CMS you can expect payment updates and quality care incentives.

Provisions in the 2009 IPPS final rule include:

  • The final transition to 100 percent cost-based payment rates
  • A requirement for hospital cost reports to distinguish between high and low cost supplies and devices
  • A final transition to Medicare severity diagnosis-related groups (MS-DRGs), and “modest changes” to the program
  • IPPS 2009 rates update of 3.6 percent for inflation (1.6 percent for hospitals that don’t submit quality data). CMS estimates Medicare spending to increase 1.8 percent in 2009, which will reduce the IPPS rate by 0.9 percent. This is in addition to the 0.6 percent reduction carried over from the 2008 IPPS final rule, according to HealthLeaders Media.
  • An objective analysis of how payments would change if the Medicare Payment Advisory Commission (MedPAC) wage index reform proposal is adapted
  • Twenty percent of the budget neutrality adjustment calculated on a state-by-state basis and 80 percent calculated on a national basis
  • The criteria for new geographic reclassification phased in
  • A higher-paying MS-DRG in cases using a total artificial heart, as well as new technology Add-On payments in approved clinical trial settings
  • New Emergency Medical Treatment and Labor Act (EMTALA) guidelines
  • The current Medicare Advantage regulation amended to allow collection of encounter-level data from MA organizations for services furnished to their enrollees
  • The capital IPPS teaching adjustment phased out
  • Capital Indirect Graduate Medical Education (IME) payments reduced to half of the amount provided under the current formula
  • Rebased payment rates for sole community hospitals (SCHs) based on 2006 hospital-specific rates, if doing so results in a higher payment rate than in 1982, 1987 or 1996

The final rule also includes 367 additions (most of which appear in the August issue of Coding Edge), 61 revisions and 25 deletions to ICD-9-CM codes.

Due to length, CMS did not publish Tables 6G and 6H (additions to and deletions from the Complications and Comorbidity Exclusion List, respectively) in the final rule. They are available on the Acute Inpatient PPS section of the CMS Web site.

The final rule, effective for discharges on or after Oct. 1 through Sept. 30, 2009, is on the CMS Web site, and is scheduled to appear in the August 19 Federal Register.

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9 Responses to “Hospitals Have 2009 IPPS Final Rule”

  1. Vicki Fischer says:

    This is frustrating. Question on Edge Blast is Which of the following dx’s are deleted in the 2009 IPPS final rule? A little help on how to navigate to this would have been nice. I looked for over 30minutes and gave up because I could not find it. Not that I didn’t try, not that I don’t use the CMS Website practically every day. I don’t do inpt, didn’t know I needed to be an expert in IPPS to do the edgeblast now.

  2. Adela Berumen says:

    I agree with Vicki!
    It seems like it is getting harder and harder to find what we need for these tests. Who has the time to spend more than 30 mins to read through all this stuff!
    I don’t even have a computer at home to look for this stuff, I have to use my computer on my lunch break, then I can only look for a little while!!
    I’m not saying to give us the anwser, but try to make it reasonable to find!!

  3. Iris A Ballou, CPC says:

    I also agree with Vicki and Adela! I called up website after website before I finally was able to uncover the required code. I also don’t have time at work to research on the web. I spent approximately 45 minutes to an hour trying to find the answer to this one question. While I don’t object to referring to other websites to obtain the answers, does it have to be such a ‘scavenger hunt’ of a search?

  4. DEBBIE REYNOLDS says:

    I AGREE WITH EVERYONE ELSE ON THIS. 45 MINUTES IN TO THIS, AND I STILL CAN’T FIND THE ANSWER. ALL OF THIS FOR 1/2 A POINT. REDICULOUS.

  5. DEBBIE REYNOLDS says:

    go to the cms website. type in deleted codes. upload it and it’s right there. in the august issue, it was recommended we “pay-it-forward”. hope this helps.

  6. P MAYFIELD, CPC says:

    I thought is was just me. I am having a hard time finding the answer also. I agree
    with Vicki and Adela.

  7. D. Huber,CPC says:

    I felt like I was taking the 5 hr exam again. This is too much research that has to go into a question for which we are only getting 1/2 a point for the whole quiz. Come on, loosen up!

  8. Valorie C. Verreaux says:

    I am a brand new coder-apprentice, and I have been so motivated to do the reading and quizes in “The Edge” magazine, and am learning a lot while enjoying the “challenge.” But I have only recently started looking at these “Edge Blasts” and agree with the above comments in that there are too many technical hurdles to jump over in order to, not only try to earn a CE or two, but to feel any facility in actually learning or processing the material’s contents. The frustration level impedes learning. So, thanks so much for all you do to provide these learning opportunities for us and maybe you could look at the excellent formatting from your magazine and apply it to the “Edge Blast. Thank you for your work and your “invitation” to give feedback!!!

  9. Susan says:

    I agree with all of you, and I know for a fact that if you work in a hospital you are timed on how many charts you code every 15 minutes. I am in an online RHIT degree program, and the quality of the classes is terrible. This material is cryptic at best, as if designed to purposefully be difficult.

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