I have been preparing for the three August webinars on the Inpatient Prospective Payment System (IPPS) for the 2025 fiscal year (FY). The final rule is scheduled to be released before or on Aug. 2. My experience is that the proposed rule provides an indication of the information in final rule; the proposed rule is 1,902 pages.
Your comments can be submitted at https://www.regulations.gov; follow the directions under the “Submit a Comment” tab. The proposed rule is numbered CMS-1808-P.
Diagnosis-Related Group (DRG) changes for consideration for FY 2026 must be submitted by Oct. 20 via MEARIS. The website is https://mearis.cms.gov/public/home.
Seven diagnosis codes that fall in the Social Determinants of Health (SDoH) range have been recommended to change from non-CC (complication or comorbidity) to CC severity status. These codes are Z59.10 (inadequate housing, unspecified); Z59.11 (inadequate housing environmental temperature); Z59.12 (inadequate housing utilities); Z59.19 (other inadequate housing); Z59.811 (housing instability, housed, with risk of homelessness); Z59.812 (housing instability, housed, homelessness in past 12 months); and Z59.819 (housing instability, housed, unspecified). It is important to discuss these codes with the coding staff, as well as in your facility-specific coding guidelines.
There are 13 changes recommended to MS-DRGs. There were no recommended changes for MS-DRGs 981-983 or 987-989.
With regards to New Technology Add-On Payments (NTAPs), 24 items are recommended to be continued from FY 2024, and seven items are listed as discontinued. Sixteen applications for NTAPs were received, but one was not eligible and three were withdrawn. For Alternative Pathways NTAPs, 23 applications were received. Seven applications did not meet the requirements, and two were withdrawn. Of the remaining applications, 12 are for Breakthrough Device designation and two are designated as Qualified Infectious Disease Product (QIDP).
It is important to review NTAPs with hospital departments on a regular basis to ensure that they are coded and that your facility receives additional reimbursement. The regular review will ensure that you capture any changes over the year. Another approach is to share the NTAP list with the chargemaster coordinator, so when an item on the NTAP list is added to the chargemaster, you will be notified. Document the NTAPs in your facility-specific coding guidelines, along with where the documentation may be found. The list of NTAPs for FY 2024 is found on the FY 2024 IPPS Final Rule website. The file is MAC (Medicare Administrative Contractor) Implementation File 8. In the August DRG session, we will review the final list for Oct. 1.
There is meaningful information in the IPPS Proposed Rule for FY 2025. This information can be used for preparation.
Resources:
IPPS FY25 Proposed Rule: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2025-ipps-proposed-rule-home-page
IPPS FY24 NTAP File:
The Centers for Medicare & Medicaid Services (CMS) has issued a Final Rule that advances policies for the Medicaid Drug Rebate Program (MDRP). Identifying and
I was recently presented with a case and asked about the proper way to handle it, and I thought it would be a good matter
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