APPENDIX D MEDICARE REIMBURSEMENT TO HOSPITALS

CONTENTS

General Summary
Basic Payment System

• Transition Period
• Update Factors
• DRG Weighting Factors
• Source and Calculation of the Hospital Wage Index
• Sample Payment Calculation

Additional Payment Amounts

• Graduate Medical Education
• Disproportionate Share Hospitals
• ESRD Beneficiary Discharges
• Outliers

Payment for Capital
Payments on a Reasonable Cost Basis

• Physicians in Teaching Hospitals
• Organ Acquisition Costs
• Passthrough Payments for Hemophilia Inpatients
• Bad Debts of Medicare Beneficiaries

Special Treatment of Certain Facilities Under PPS

• Sole Community Hospitals
• Medicare Dependent Hospitals
• Referral Centers
• Hospitals in Rural Counties Treated as Urban Counties

Hospitals Excluded From the Prospective Payment System
Administration

• Prospective Payment Assessment Commission
• Administrative and Judicial Review
• Review Activities

Historical Trends in PPS Payments, Costs, and Margins

• Medicare Payments to Hospitals
• Policy Changes and PPS Operating Payments
• Distribution of PPS Hospitals, Cases, and Operating Payments
• Trends in PPS Operating Payments and Costs
• PPS Inpatient Margins
• Margins by Hospital Type
• Additional Hospital Data Part 1
• Additional Hospital Data Part 2, Table D-17, Wage Index for Urban Areas, Fiscal Year 1996
• Additional Hospital Data Part 3, Table D-17, Wage Index for Urban Areas, Fiscal Year 1996
• Additional Hospital Data Part 4
• Additional Hospital Data Part 5, Table D-20, Diagnosis-Related Groups Relative Weights, Fiscal Years 1995 and 1996
• Additional Hospital Data Part 6, Table D-20, Diagnosis-Related Groups Relative Weights, Fiscal Years 1995 and 1996
• Additional Hospital Data Part 7, Table D-20, Diagnosis-Related Groups Relative Weights, Fiscal Years 1995 and 1996
• Additional Hospital Data Part 8, Table D-20, Diagnosis-Related Groups Relative Weights, Fiscal Years 1995 and 1996
• Additional Hospital Data Part 9, Table D-20, Diagnosis-Related Groups Relative Weights, Fiscal Years 1995 and 1996

References


Return to Contents