IRF PPS PS & R and Claims Issues
The Prospective Payment System (PPS) for IRF was effective for cost reporting periods beginning on and after January 1, 2002. While programming PS&R to report IRF PPS services, it was found that APASS was not correctly populating the PPS federal specific and hospital specific fields in the claim record. This problem was corrected in late January, however to fix existing claim records it has been necessary to adjust all claims processed under IRF PPS. The majority of these adjustments does not impact payment and have not generated a remittance advice. In those cases where the adjusted claims have priced differently than the original, a remittance advice has been produced.
We have now loaded all IRF PPS claims into PS&R and have found that not all of the adjustments have found their way into PS&R, so that there may still be some inaccurate data. While the PS&R does include all of the days, charges and net reimbursement associated with IRF PPS services, there may be Federal Specific and Hospital Specific amounts missing. This will be indicated by an amount report in the OTHER field (1). In order to allow you to file your Medicare cost report without computing an unwarranted overpayment, we are recommending that the Federal Specific amount reported in PS&R, be increased by the amount reported in the OTHER field.
| Federal Specific | $ 257,119.33 | |
| Other | $ 17,775.80 | |
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| Adjusted Federal Specific | $ 274,895.13 |
TK P R O V I D E R S T A T I S T I C A L A N D R E I M B U R S E M E N T S Y S T E M
PROGRAM ID: MD430502 - V28.0 PAGE: 421
PAID DATES: 01/01/02 THRU 04/15/03 PROVIDER SUMMARY REPORT REPORT #: OD44203
RUN DATE: 04/23/03 INPATIENT REHABILITATION - PART A REPORT TYPE: 11R
PROVIDER FYE: 12/31 PROSPECTIVE PAYMENT PROVIDER
PROVIDER NUMBER: 00T000 Rehabilitation Hosp
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REVENUE SERVICES FOR PERIOD SERVICES FOR PERIOD SERVICES FOR PERIOD SERVICES FOR PERIOD
CODE DESCRIPTION 01/01/02 - 12/31/02 00/00/00 - 00/00/00 00/00/00 - 00/00/00 00/00/00 - 00/00/00
UNITS CHARGES UNITS CHARGES UNITS CHARGES UNITS CHARGES
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TOTAL CHARGES $609,680.45 $.00 $.00 $.00
________________ ________________ ________________ ________________
________________ ________________ ________________ ________________
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FEDERAL SPECIFIC $257,119.33 $.00 $.00 $.00
COST OUTLIER $634.99 $.00 $.00 $.00
LIP PAYMENTS $2,216.15 $.00 $.00 $.00
________________ ________________ ________________ ________________
FEDERAL PAYMENTS $259,970.47 $.00 $.00 $.00
HOSPITAL SPECIFIC $110,477.08 $.00 $.00 $.00
GROSS REIMBURSEMENT $370,447.55 $.00 $.00 $.00
LESS:
CASH DEDUCTIBLE $2,436.00 $.00 $.00 $.00
BLOOD DEDUCTIBLE $.00 $.00 $.00 $.00
COINSURANCE $.00 $.00 $.00 $.00
NET PRIMARY PAYOR
PAYMENTS MADE UNDER MSP $.00 $.00 $.00 $.00
OTHER (1) $17,775.80- $.00 $.00 $.00
________________ ________________ ________________ ________________
NET REIMBURSEMENT $385,787.35 $.00 $.00 $.00
________________ ________________ ________________ ________________
________________ ________________ ________________ ________________
INFORMATIONAL ONLY:
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INTEREST PAYMENTS $.00 $.00 $.00 $.00
PENALTY AMOUNT $.00 $.00 $.00 $.00
CMG DISCHARGE FRACTION 0.0000 0.0000 0.0000 0.0000
CMG WEIGHT 0.0000 0.0000 0.0000 0.0000
CMG WEIGHT FRACTION 0.0000 0.0000 0.0000 0.0000
We will be correcting the data reporting in PS&R and will use the corrected data for tentative settlement and final settlement. We apologize for any inconvenience this situation may cause. If you have any questions in regard to this matter, please contact the Audit Supervisor assigned to your facility at 1-866-734-9444. Refer to our Home Office Contacts for names and extensions.
Page Last Updated: Tuesday, 15-Jul-2008 10:37:32 CDT
