(Medicare Claims Processing Manual)

9(4)V9(2)   Old Capital Hold Harmless Rate   Enter the hospital's allowable inpatient "old" capital costs per discharge incurred for assets acquired before December 31, 1990, for capital PPS.  Update annually.  46 198-202  9V9(4)   New Capital -Hold Harmless Ratio   Enter the ratio of the hospital's allowable inpatient costs for new capital to the hospital's total allowable inpatient capital costs.  Update annually.  47 203-206 9V9(3)  Capital Cost -to-Charge Ratio  Derived from the latest cost report and corresponding charge data from the billing file.  For hospitals for which the MAC is unable to compute a reasonable cost- to-charge ratio, it uses the appropriate statewide average cost -to-charge ratio calculated annu ally by CMS and published in the "Federal Register."  A provider may submit evidence to justify a capital cost- to-charge ratio that lies outside a 3 standard deviation band. The MAC uses the hospital's ratio rather than the statewide average if it agrees t he hospital's rate is justified.  See below for a detailed description of the methodology to be used to determine the CCR for Acute Care Hospital Inpatient and LTCH Prospective Payment Systems.  48 207  X(1)   New Hospital   Enter "Y" for the first 2 years that a new hospital is in operation.  Leave blank if hospital is not within first 2 years of operation.  49 208-212  9V9(4)   Capital Indirect Medical Education Ratio  This is for IPPS hospitals and IRFs only.  Enter the ratio of residents/interns to the hospital's average daily census.  Calculate by dividing the hospital's full -time Data Element  File Position  Format  Title  Description  equivalent total of residents during the fiscal year by the hospital's total inpatient days.  (See 20.4.1  for inpatient acute hospital and 140.2.4.3 and 140.2.4.5.1 for IRFs.)  Zero -fill for a non -teaching hospital.  50 213-218 9(4)V9(2)   Capital Exception Payment Rate  The per discharge exception payment to which a hospital is entitled.  (See 20.4.7  above.)  51 219-219 X VBP Participant  Enter Y if participating in Hospital Value Based Purchasing.  Enter N if not participating.  Note if Data Element 34 (Hospital Quality Ind) is blank, then this field must = N.  52 220-231 9V9(11)  VBP Adjustment  Enter VBP Adjustment Factor.  If Data Element 51 = N, leave blank.  53 232-232 X HRR Indicator  Enter 0 if not participating in Hospital Readmissions Reduction program. Enter 1 if participating in Hospital Readmissions Reduction program and payment adjustment is not 1.0000.  Enter 2 if participating in Hospital Readmissions Reduction program and payment adjustment is equal to  1.0000.   54 233-237 9V9(4)  HRR Adjustment  Enter HRR Adjustment Factor if 1 is entered in Data Element 53.   Leave blank if 0 or 2 is entered in Data Element 53.  55 238-240 V999  Bundle Model 1 Discount Enter the discount % for hospitals participating in Bundled Payments for Care Improvement Initiative (BPCI), Model 1 (demo code 61).  56 241-241 X HAC Reduction  Indicator Enter a Y if the hospital is subject to a reduction under the HAC Reduction Program. Enter a N if the hospital is NOT subject to a reduction under the HAC Reduction Program.  57 242-250 9(7)V99  Uncompensated Care Amount Enter the estimated per discharge uncompensated care payment (UCP) amount or enter the total of the estimated per discharge UCP amount and estimated per discharge supplemental payment amount, calculated and published by CMS for each hospital. Effective 10/1/2022, the estimated per discharge supplemental Data Element  File Position  Format  Title  Description  payment is for eligible Indian Health Service/Tribal hospitals and hospitals located in Puerto Rico.  58 251-251 X Electronic Health Records (EHR) Program Reduction Enter a Y if the hospital is subject to a reduction due to NOT  being an EHR meaningful user. Leave blank if the hospital is an Electronic Health Records meaningful user.  59    252-258     9V9(6)      LV Adjustment Factor     Enter the low -volume hospital payment adjustment factor calculated in accordance with the low -volume hospital payment regulations at  412.101. 60 259-263 9(5) County Code  Enter the County Code. Must be 5 numbers.   61 264-268 9V9999  Medicare Performance Adjustment (MPA)  Enter the MPA percentage calculated and published by the Centers for Medicare & Medicaid Services (CMS).  62 269-269   X(1)   LTCH DPP Indicator   Enter a Y if the LTCH is subject to the DPP payment adjustment. Leave blank if the LTCH is not subject to the DPP payment adjustment.  63 270-275 9(2) V9(4)  Supplemental Wage Index  Enter the supplemental wage index that certain providers may be assigned.  Enter zeroes if it does not apply.  64 276-276 X(1) Supplemental Wage Index Flag  Enter the supplemental wage index flag that certain providers may be assigned: 1=Prior Year Wage Index 2=Special IPPS-comparable Wage Index*  3=Future use  Enter blank if it does not apply  *Only for LTCH providers. Pricer will override the otherwise determined IPPS -comparable wage index with this value.   65 277-285 9(7)V99  Pass Through Amount for Allogeneic Stem Cell Acquisition  Enter the per diem amount based on the interim payments to the hospital. Include acquisition amounts for allogeneic stem cell transplants. Zero -fill if this does not apply. Data Element  File Position  Format  Title  Description  66 286-291 9(4)V9(2)  Pass Through Amount for Direct Medical Education (Medicare Advantage (MA) Exclusion) Per diem amount of direct graduate medical education to be excluded from MA capitation rates per regulation. Zero -fill if this does not apply. 67 292-297 9(4)V9(2)  Pass Through Amount for Kidney Acquisition (MA Exclusion)  Per diem amount of kidney acquisition costs to be excluded from MA capitation rates per regulation.  Zero- fill if this does not apply. 68 298-306 9(7)V99  Pass Through Amount for Domestic N95 Respirator Procurement  Enter the per diem amount based on the interim payments to the hospital. Include payment adjustments for the additional cost for procurement of wholly domestically made NIOSH -approved surgical N95 respirators.   69 307-310 X(4)  Filler                         Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#  R12306CP  10/19/2023  Processing Claims When the Dates of Service Are Beyond the Time Limit for the Patient Assessment  01/24/2024  13402  R12239CP   09/06/2023  Instructions To Process Services During Disenrollment From The Programs Of All -Inclusive Care For The Elderly (PACE)  01/02/2024  13248  R12234CP  08/31/2023  Fiscal Year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long- Term Care Hospital (LTCH) PPS Changes  10/02/2023  13306  R12148CP  07/21/2023  Instructions To Process Services During Disenrollment From The Programs Of All-Inclusive Care For The Elderly (PACE )- Rescinded and replaced by transmittal 12239  01/02/2024  13248  R11963CP  04/20/2023  Religious Nonmedical Health Care Institution Provisions of the Consolidated Appropriations Act (CAA) of 2023  10/02/2023  13108  R11639CP  10/07/2022  Provider Specific File (PSF) changes for Direct Medical Education (DME), Direct Graduate Medical Education (DGME), Organ Acquisition Cost (OAC) and Kidney Acquisition Costs (KAC)  04/03/2023  12852  R11543CP  08/05/2022  Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2023  10/03/2022  12859  R11540CP  08/05/2022  Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2023  10/03/2022  12807  R11396CP  05/04/2022  Update to Chapters 3, 4, 27 and 37 of Publication (Pub.) 100- 04 Medicare Claims Processing Manual to Remove Reference to the Term "OSCAR"  10/03/2022  12715  R11348CP  04/07/2022  Revisions to Chapters 3, Inpatient Hospital Billing of the Medicare Claims Processing Manual (Pub 100-04), 18, Preventive and Screening Services of the Medicare Claims Processing Manual (Pub 100-04), and 32 Billing Requirements for Special Services o f the Medicare Claims Processing Manual (Pub 100-04) to Update Coding  05/09/2022  12602  Rev #  Issue Date  Subject  Impl Date  CR#   R11140CP  12/02/2021  Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3 and 17   01/04/2022  12525  R11059CP  10/21/2021  April 2022 Update to the Java Medicare Code Editor (MCE) for New Edit 20 - Unspecified Code Edit  04/04/2022  12471  R11075CP  10/28/2021  Revision to Chapter 3 to Update Instructions for Handling Inpatient Rehabilitation Facility (IRF) Claims  12/01/2021  12500  R11035CP  10/13/2021  Revisions to Chapters  3, 18, and 32 to Update  Coding  11/17/2021  12377  R11039CP  10/05/2021  Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2022  10/04/2021  12417  R11019CP  09/27/2021  Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2022 - Rescinded and replaced by transmittal 11039  10/04/2021  12417  R10952CP  08/19/2021  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 3, Section 40.2.4 Inpatient Prospective Payment System (IPPS) Transfers Between Hospitals  09/20/2021  12360  R10943CP  08/11/2021  Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2022   10/04/2021  12364  R10944CP  08/12/2021  Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2022 - Rescinded and replaced by transmittal 1101 9 10/04/2021  12417  R10696CP   03/31/2021  Penalty for Delayed Request for Anticipated Payment (RAP) Submission  01/04/2021  11855  R10403CP