Question

Please fill the following tables for the postacute care prospective payment systems:

	SNFPPS Payment Process	LTCHPPS Payment Process	IRFPPS Payment Process	HHPPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)
Patient data that must be presented with the claim
Facility level adjustments
Patient level adjustments
Outlier payment processes, if applicable (write a few sentences for the process)
Other adjustments, if any

Answer 1

	SNFPPS Payment Process	LTCHPPS Payment Process	IRFPPS Payment Process	HHPPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)	RUG determines payment. The RUG is based on therapy and service use, presence of medical conditions, and ADL (activity of day living) score.	MS-LTC-DRGs are based on the expected relative costliness of treatment for patients in a group.The patients are assigned a group based on their principal diagnosis, secondary diagnoses, procedures performed, age, sex, and discharge status.	Case-mix-groups (CMGs) determine payment. CMGs have tiers within them that are assigned to each patient. Each CMG tier has a specific weight which shows the costliness of patients in that CMG tier in relation to that of the average Medicare IRF patient.	HIPPS code is assigned is determined. Therapy visits, Clinical dimension score, functional dimension score, Service dimension, and Supply severity all help determine the HHPPS code.
Patient data that must be presented with the claim	therapy and service use, presence of medical conditions, and ADL (activity of day living) score	Principle diagnosis, secondary diagnosis, procedures, age, sex, discharge status	Diagnosis required rehabilitation, functional status, cognitive status, age, comorbidities	Clinical, functional, and service utilization scores
Facility level adjustments	Facility wage index, location	Hospital wage index	Location, teaching factor, share of low-income patients	Home healthcare base rate
Patient level adjustments	ADL score	Length of stay	Tier they fall into and length of stay	Number of visits
Outlier payment processes, if applicable (write a few sentences for the process)		There are two outlier payment processes. One is the short-stay outlier procedure which occurs when the LOS <= 5/6 of the Geometric mean LOS for the MS-LTC-DRG. The second high-cost outlier payment which refers to High-cost outlier cases being identified by comparing their costs to a threshold.	There is a high-cost outlier payment. The High-cost outlier cases are identified by comparing their costs to a threshold that is the CMG payment for the case plus a fixed loss amount.	A high-cost outlier payment is used. The short-stay outlier payment is used if there are less than 5 visits.
Other adjustments, if any	Geographic factors	Case-mix adjusted payment		Low-utilization payment adjustment, partial episode payment adjustment