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CMS final rule requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary.
In the FY 2024 IPPS/LTCH PPS proposed rule, CMS is proposing to: Establish a validation reconsideration process for hospitals that failed to meet data validation requirements, beginning with the FY 2025 program year, affecting CY 2022 discharges.
In an effort to address direct care workforce shortages, CMS proposes to require that at least 80 percent of Medicaid payments in a State for homemaker, home health aide, and personal care services be spent on compensation for direct care workers.
The IPPS pays a flat rate based on the average charges across all hospitals for a specific diagnosis, regardless of whether that particular patient costs more or less. Everything from an aspirin to an artificial hip is included in the package price to the hospital.
CMS issued the 2024 benefit year premium adjustment percentage, the maximum annual limitation on cost sharing, the reduced maximum annual limitation on cost sharing, and the required contribution percentage (payment parameters) in guidance on December 12, 2022, consistent with policy finalized in the 2022 Payment
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The payment amount is based on each hospitals share of the total UCC reported by IPPS facilities. Once determined, the amount is paid to the hospitals as a flat amount per discharge, using the estimated number of Medicare discharges from prior cost report information.
The Centers for Medicare Medicaid Services today issued a proposed rule that would increase Medicare inpatient prospective payment system rates by a net 2.8% in fiscal year 2024, compared with FY 2023, for hospitals that are meaningful users of electronic health records and submit quality measure data.
The system for payment, known as the Inpatient Prospective Payment System (IPPS), categorizes cases into diagnoses-related groups (DRGs) that are then weighted based on resources used to treat Medicare beneficiaries in those groups.

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