Inpatient Claims May Have a Short Delay

(PYA Alert dated October 16, 2007)

The Centers for Medicare & Medicaid Services (CMS) issued a Joint Signature Memorandum (JSM-07548) dated September 28, 2007. In this memo, Medicare contractors were instructed to hold all Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS claims with discharge dates on or after October 1, 2007 until further notice. CMS was researching to determine if revised IPPS and LTCH Pricers needed to be reissued.

Other items causing this delay included technical corrections to the IPPS final rule which CMS put on display September 27, 2007. The impact analysis related to these corrections appears to be benefiting Rural hospitals more than Urban hospitals. Additionally, on September 27th Congress enacted an Extension Act. This Act reduced a planned “behavioral offset” to the Medicare-Severity Diagnosis-Related Groups to -0.6% from -1.2% in FY 2008 and to -0.9% from -1.8% in FY 2009.

At least one intermediary has indicated these CMS holds were released and IPPS and LTCH claims will be released for processing October 17, 2007. We recommend you monitor your claims processing for timely and accurate payment. This claims hold did not affect payments for Outpatient, Psychiatric or Rehabilitation Prospective Payment Systems.

If you have questions on this or other Medicare issues, please contact Lisa Price or Butch Bullock at (800) 270-9629.

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

back to PYA Alerts