Long-Term Care Hospital PPS PC Pricer

COBOL Personal Computer (PC) Pricers Conversion To Java Web Based Applications

Please advise. Providers and other payers use PC Pricer applications to estimate Medicare payments. Over the next year, CMS will stop producing new versions of the downloadable PC Pricers and issue them as web-based applications. CMS will continue to communicate the status of each PC Pricer conversion with our users as each Web based Pricer becomes available. 

The Balanced Budget Refinement Act (BBRA) of 1999 and the Benefits Improvement Act (BIPA) of 2000 established the Prospective Payment System (PPS) for operating and capital-related costs of hospital inpatient stays in long-term care hospitals (LTCHs) under Medicare Part A. Under this system, a hospital is paid a fixed amount for each patient discharged in a particular treatment category or Diagnosis Related Group (DRG). This fixed amount is intended to cover the cost of treating a typical patient for a particular DRG. This PC Pricer software will be released on a quarterly basis. The criteria for classification as a LTCH is outlined in section 1886(d)(1)(B)(iv) of the Social Security Act. The PPS for LTCHs is effective for cost reporting periods beginning on or after October 1, 2002.

NOTE:  The large urban add-on component of the LTCH PPS short-stay outlier (SSO) "IPPS comparable amount" for CBSA 39300 was inadvertently not applied in version 7.5 of the LTCH PPS Pricer.   This omission could have affected the SSO payment calculations for LTCHs located in Massachusetts and Rhode Island that are in CBSA 39300 in that version of the Pricer.











Page Last Modified:
01/22/2021 11:53 AM