Inpatient Psychiatric Facilities Impacted by Affordable Care Act, ICD-10

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Inpatient Psychiatric Facilities Impacted by Affordable Care Act, ICD-10

Section 1886(s)(4)(C) of the Social Security Act, amended by sections 3401(f) and 10322(a) of the Affordable Care Act requires IPFs to report quality data for 6 quality measures starting in fiscal 2013 for Medicare beneficiaries.   Beginning in FY 2015, two quality measures are added.   Failure to comply with these regulations will result in a 2 percent reduction to the applicable base rate for IPFs.  (Source: Medicare Learning Network publication Inpatient Psychiatric Facility Prospective Payment System).

A Behavioral specialty provider recently stated, “…we don’t use DRGs we use Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).”  In fact, the facility is indeed using DRGs. According to CMS:

Mike Arrigo, Managing Partner & CEO No World Borders, Inc.

Michael Arrigo, Managing Partner, No World Borders

…IPF PPS, Federal per diem rates include inpatient operating and capital-related costs (including routine and ancillary services) and are determined based on:

  • Geographic factors:
    • A hospital wage index value is assigned to account for geographic differences in wage
    • The non-labor-related portion accounts for higher cost of living for IPFs located in Alaska and Hawaii;
  • Patient characteristics:
    • Medicare Severity-Diagnosis Related Group (MS-DRG) classification;
    • Age;
    • Presence of specified comorbidities; and
    • Length of stay; and
  • Facility characteristics:
    • A 17 percent payment adjustment for rural facilities due to their higher costs; and
    • Teaching hospitals receive payment to account for indirect medical education costs…

Why does this matter in the context of ICD-10?   The quality measures will be based on diagnosis and procedures coded in ICD-10 beginning October 1, 2015.

For more information on behavioral health, ICD-10, DSM-5 and DSM-IV see related blog posts.

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By | 2017-05-04T04:06:21+00:00 August 2nd, 2015|Affordable Care Act, DSM-5, ICD-10|0 Comments

About the Author:

Michael is Managing Partner & CEO of No World Borders, a leading health care management and IT consulting firm. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $4 billion in healthcare mergers and acquisitions. Education: UC Irvine – Economics and Computer Science, University of Southern California – Business, Stanford Medical School – Biomedical Informatics, Harvard Law School – Bioethics.

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