National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2008

MLN Matters Number: MM5694
Related Change Request (CR) #: 5694
Related CR Release Date: August 24, 2007
Effective Date: October 1, 2007
Related CR Transmittal #: R1323CP
Implementation Date: October 1, 2007

Provider Types Affected
Providers submitting claims to Medicare fiscal intermediaries (FI) and Part A/B Medicare Administrative Contractors (A/B MAC)) for IRF PPS services provided to Medicare beneficiaries.  

Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5694, which provides details about the annual IRF PPS rate updates for Fiscal Year (FY) 2008.  

What You Need to Know
Updated rates are effective for claims with discharges that fall on or after October 1, 2007, and on or before September 30, 2008.  

What You Need to Do
See the Background section of this article for further details regarding this IRF annual update.

Background
On August 7, 2001, the Centers for Medicare & Medicaid Services (CMS) published a Final Rule in the Federal Register ( http://www.access.gpo.gov/su_docs/fedreg/a010807c.html ) that established the Prospective Payment System (PPS) for Inpatient Rehabilitation Facilities (IRF) as authorized under the Social Security Act (Section1886(j)). In that final rule, CMS set forth per discharge federal rates for federal fiscal year (FY) 2002. These IRF PPS payment rates became effective for cost reporting periods beginning on or after January 1, 2002, and annual updates to the IRF PPS rates are required by the Social Security Act (Section 1886(j)(3)(C)).

On August 7, 2007, CMS published the FY 2008 IRF PPS Final Rule in the Federal Register ( http://www.cms.hhs.gov/inpatientrehabfacpps/downloads/cms1551f.pdf ) which provides the prospective payment rates applicable for IRFs for FY 2008.

A new IRF PRICER software package will be released prior to October 1, 2007 that will contain the updated rates that are effective for claims with discharges that fall on or after October 1, 2007 through September 30, 2008. Your FI or Part A/B MAC will install the new revised Pricer program in a timely fashion to ensure you receive accurate payments for IRF PPS claims with discharges occurring on or after October 1, 2007 through September 30, 2008.

The IRF PPS FY 2008 rates applicable to discharges on or after October 1, 2007 through September 30, 2008 are as shown in the following table:

Additional Information
The official instruction, CR5694, issued to your Medicare FI or A/B MAC regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R1323CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare FI or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.