Periodic Interim Payment (PIP) Eligibility
CMS published the final rule on November 15, 2004 regarding the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). Payments for IPF services delivered for cost reporting periods beginning on or after January 1, 2005 will be based on policies set forth in the final rule.
There is an adjustment to the standardized Federal per diem base rate to account for the costs associated with maintaining a full-service Emergency Department (ED). The adjustment is available to psychiatric hospitals and acute care hospitals with a distinct part psychiatric unit, with an ED staffed and equipped to furnish a comprehensive array of emergency services that meets the definition of a "dedicated emergency department" in §489.24 and the definition of "provider-based status" in §413.65.
Providers must notify their Fiscal Intermediary (FI) within 30 days prior to their fiscal year begin date, if they believe they are entitled to the ED adjustment. However, for providers whose cost reporting periods begin January 1, 2005 through March 1, 2005, providers must notify their FI on or before March 7, 2005 . Providers must submit supporting documentation (e.g. state license) to support the ED adjustment. We will not accept attestation statements.
Below are the Medicare regulations that define a "dedicated emergency department". We've provided a few examples of acceptable documentation to support the ED adjustment, see below:
42 CFR §489.24
Dedicated emergency department means any department or facility of the hospital, regardless of whether it is located on or off the main hospital campus, that meets at least one of the following requirements:
- It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department;
Example: State License - It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or
Example: Pamphlets, Yellow-pages, Websites, etc. - During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.
Example: Outpatient Treatment Log
Page Last Updated: Monday, 09-Jun-2008 13:18:42 CDT
