Mass-Adjustment of Specified Inpatient Prospective Payment System (IPPS) Transplant Claims Paid an Outlier

The Centers for Medicare & Medicaid Services (CMS) has identified a claims processing error that incorrectly considers acquisition charges in the outlier calculation for the following type of organ transplant claims: Heart, Liver, Lung, Intestinal Alone, and Pancreas Alone. This claims processing problem will be corrected on October 5, 2009. At that time, adjustments will be made to claims paid in error with all adjustments completed no later than December 1, 2009. The organ transplant claims impacted have an 11X type of bill, discharge date of October 1, 2007, or later, Medicare Severity Diagnosis Related Group of 001, 002, 005, 006, 007, or 010, and a Value Code of 17. We regret any inconvenience you have experienced related to this problem.

Page Last Updated: Thursday, 18-Mar-2010 05:48:42 CDT