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November 22, 2016

LTCH: Clarification of Immediately Preceding Hospitals for Exclusion from Site Neutral Payment Rate

The description of a qualifying immediately preceding hospital as Inpatient Prospective Payment System (IPPS) hospital in MLN Matters Article MM9015External PDF has been changed to "subsection (d) hospital” to be consistent with the Code of Federal Regulations. Discharges in cost reporting periods beginning on or after October 1, 2015, may have been incorrectly paid at the site neutral rate if:

  • The immediately preceding hospital claim was not present in Medicare Claims processing claims history, or
  • The patient came from a ‘subsection (d) “immediately preceding hospital other than an IPPS hospital.

Long-Term Care Hospitals (LTCHs) should contact their Medicare Administrative Contractors (MACs) about these claims. MACs will work with LTCHs to obtain additional documentation for affected claims and make any appropriate adjustments to payment.

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