ltch 25 percent rule

Elimination of the “25-Percent Threshold Policy” Adjustment: CMS is eliminating the 25% threshold policy because it believes aggregate LTCH PPS payments are sufficient. The CMS rule, which has been delayed for ten years, allows for no more than 25 percent of patients to come from one inpatient acute care hospital in one quarter. • The 25 percent rule is arbitrary. The LTCH 25 Percent Rule and the IRF 60 Percent Rule. The 25 percent rule The 25 percent rule reduces payments for Under the 25 Percent Rule, an LTCH is allowed to admit up to 25% of its patients from a single general acute care hospital; for patients admitted past the 25% threshold, an LTCH faces a significant Medicare reimbursement reduction. under the LTCH PPS payment rate. However, the 4 Percent Rule, more importantly, guides how much money you can withdraw annually once you're retired, without cutting into your investment principal. Overall, under the changes included in the Final Rule, CMS projects that LTCH PPS payments will increase by approximately 0.9 percent, or $39 million, in FY 2019. This is a flawed and arbitrary manner in which to create a policy. The goal of this rule is to insure that admissions to LTCHs are made for clinical rather than financial reasons. In an effort to control LTCH costs following the introduction of PPS, Medicare enacted the 25 percent rule. The 4 Percent Rule is often confused with the Multiply by 25 Rule, for obvious reasons—the 4 Percent Rule, as its name implies, assumes a 4 percent return. The 25-percent rule uses payment adjustments to create disincentives for LTCHs to admit a large share of their patients from a single ACH. Congress Short On Time To Delay LTCH 25 Percent Rule Pay Cut. The 25 percent rule is non-clinical in nature, targeting patients based on their referral source rather than clinical needs. An LTCH is paid full LTCH rates for patients admitted from any ACH until the percentage of Medicare admissions from any one ACH exceeds the applicable threshold of the LTCH’s Medicare cases. ... coding adjustment and equals the 2.6 percent market basket net of MFP less 2.25 percentage points. (A separate 5-percent threshold applies to cases transferred to co-located SNFs, IRFs, and psychiatric facilities.) “Further, given the scale of LTCH cuts under site-neutral payment, implementing the 25-Percent Rule payment penalties would unjustifiably exacerbate the instability and strain on the field, which would threaten access for the high-acuity, long-stay patients that require LTCH-level care,” he continued. The legislation reinstates the 50 percent threshold that was in effect prior to July 1, 2016, and delays the rule for nine months (October 1, 2016 through June 30, 2017). The payment rates and policies described in the IPPS/LTCH final rule (CMS-1716-F) affect ... reduced by three-quarters of the market basket update or 2.25 percentage points. As a result, it presents an access barrier for patients who are clinically appropriate for the LTCH … The 25 percent rule The 25 percent rule is intended to help ensure that LTCHs do not function as units of acute care hospitals and that decisions about admission, treatment, and discharge in both acute care hospitals and LTCHs are made for clinical rather than financial reasons. The rule sets a limit on exceeded, the LTCH receives only one payment for each interrupted-stay patient regardless of the amount of time spent at the intervening facility. Clinical needs, targeting patients based On their referral source rather than clinical needs admissions! Clinical rather than financial reasons effort to control LTCH costs following the introduction of,. Snfs, IRFs, and psychiatric facilities. 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