One in every five Medicare beneficiaries is hospitalized one or more times each year. There are almost 5,000 inpatient acute-care hospitals nationwide that treat these beneficiaries. Of the approximately $300 billion dollars spent on the Medicare program each year, almost $100 billion is spent on inpatient services.
Over three-quarters of these hospitals are paid under the inpatient prospective payment system (IPPS), while nearly one quarter are paid based on costs and are called Critical Access Hospitals. The IPPS pays a flat rate based on the average charges across all hospitals for a specific diagnosis regardless of whether that particular patient costs more or less. Everything from an aspirin to an artificial hip is included in the package price to the hospital.
Under the IPPS, each case is categorized into a diagnosis-related group (DRG) to determine the base rate. Payment is also adjusted for differences in area wage costs -- and depending on the hospital and case -- teaching status, high percentage of low-income patients, the use of new technology and extremely costly cases.
This site contains member advisories, comment letters, and other educational tools to help you learn more about the IPPS.
- Apr 14, 2017 | CMS releases FY 2018 inpatient PPS proposed rule
- Apr 14, 2017 | CMS issues LTCH PPS proposed rule for FY 2018
- Apr 6, 2017 | AHA comments on CMS proposal for using Worksheet S-10 data
- Mar 13, 2017 | Medicare inpatient quality reporting deadline unchanged
- Jan 24, 2017 | CMS issues guidance on implementing MOON
- Jan 17, 2017 | CMS extends deadline for reporting 2016 eCQM data
- Jan 9, 2017 | CMS updates ICD-10 value sets for 2017 electronic clinical quality reporting
- Dec 19, 2016 | CMS announces update on eCQM value sets for 2017 performance period
- Dec 14, 2016 | CMS won't penalize failure to report PQRS data affected by coding change
- Dec 8, 2016 | CMS posts final hospital MOON for implementation by March 8
- Apr 17, 2017 | CMS Releases FY 2018 Hospital Inpatient PPS Proposed Rule
- Jan 06, 2017 | Comments on MedPAC's draft recommendations for FY 2018
- Aug 30, 2016 | AHA Comments to OMB on the Updated Medicare Outpatient Observation Notice (MOON)
- Aug 24, 2016 | Medicare Inpatient PPS: The Final Rule for FY 2017
- Aug 03, 2016 | CMS Releases FY 2017 Hospital Inpatient PPS Final Rule
- Aug 02, 2016 | Statement on Final FY 2017 Inpatient and LTCH Rule
- Jun 17, 2016 | AHA Comments on to CMS Re: Hospital IPPS Proposed Rule for FY 2017
- May 13, 2016 | Medicare Inpatient PPS: The Proposed Rule for FY 2017
- Apr 19, 2016 | CMS Issues Inpatient PPS (IPPS) Proposed Rule for FY 2017
- Feb 02, 2016 | AHA comments on CMS's Dec. 1, 2015 Notice about 0.2 percent reduction to Hospital IPPS payments