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What is IPPS (inpatient prospective payment system) for Medicare?
The purpose of the post is to briefly explain how to calculate operating and capital DRG (diagnosis related groups) payments. What are DRGs (Diagnosis Related Groups)? “Under the IPPS, each case is...
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Cost Outliers: A Brief Explanation of DRG Outliers (Part 1)
What is the purpose of cost outlier payments? Outlier payments are designed to compensate a facility for costs over and above normally expected costs. Remember that a DRG (diagnosis related group)...
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How to Calculate Operating DSH (Disproportionate Share Hospital)
How to calculate the operating DSH adjustment One area that sometimes confuses providers is the operating DSH calculation. We know operating DSH is important due to the DRG calculation. When does the...
View ArticleInput Pricing Under the Prospective Payment System (PPS)
As discussed in a precious article about PPS, we discussed labor, nonlabor, and capital costs. The purpose of this brief discussion is to explain the elements in more detail, especially because of its...
View ArticleMedicare Readmission Reduction Calculation
I came across a simple explanation of how CMS will calculate readmission reduction payments. Remember that the reduction applies to 3 categories: heart failure, acute myocardial infarction, and...
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