Summary Chart - Medicare Like Rates Training

September 12, 2007

Prepared by: Kris Locke

American Indian Health Commission

for Washington State

Facility/Service / Type of Payment / Software or
Re-pricing Options / Web Location / Notes
Inpatient Acute / DRG / CMS PC Pricer
Commercial Software:
IRP; 3M;
MicroDyn; Others / www.cms.hhs.gov/PC/Pricer/ / Pub 100-04 Chapter 3 at cms.hhs.gov/manuals/downloads/clm104c03.pdf
Updated every October
CMS Contact: Sarah Shirey-Losso 410 786-0187
Inpatient Long Term Care / LTC-DRG / CMS PC Pricer
Commercial Software? / www.cms.hhs.gov/PC/Pricer/ / Pub 100-04 Chapter 3 Section 150
Updated every July, October
CMS Contact: Sarah Shirey-Losso 410 786-0187
Inpatient Rehabilitation / CMG / CMS PC Pricer
Commercial Software? / www.cms.hhs.gov/PC/Pricer/ / Pub 100-04 Chapter 3 Section 140
Updated every October
CMS Contact: Sarah Shirey-Losso 410 786-0187
Inpatient Psychiatric / Per Diem / CMS PC Pricer
Commercial Software? / www.cms.hhs.gov/PC/Pricer/ / Pub 100-04 Chapter 3 Section 190
Updated every July, October
CMS Contact: Sarah Shirey-Losso 410 786-0187
Inpatient Critical Access / Per Diem / Call Noridian
IRP / None / CMS Contact: Cindy Murphy 410 786-5733
Charges x IP CCR+1% is alternative Type of Payment
Inpatient TEFRA (Childrens and Cancer Hospitals) / Per Diem / Call Noridian
IRP / None / CMS Contact: Cindy Murphy 410 786-5733
Skilled Nursing Facility & Swing Beds / Per Diem / CMS PC Pricer / www.cms.hhs.gov/PC/Pricer/ / Updated every October
CMS Contact: Jason Kerr 410 786-2123
CAH Swing beds not included
Outpatient Acute / OPPS APC / Commercial Software ONLY:
IRP; 3M;
MicroDyn; Others / Updated quarterly
CMS Contact: Joe Bryson 410 786-2986
Outpatient Critical Access / Charges x OP Cost to Charges Ratio + 1% / Call Noridian
Manual Calculation / None / CMS Contact: Cindy Murphy 410 786-5733
Outpatient TEFRA (cancer, children’s) / Charges x OP Cost to Charges Ratio / Call Noridian
Manual Calculation / None / CMS Contact: Cindy Murphy 410 786-5733
Some are paid OPPS APC
Hospital Lab / Fee Schedule / Manual Calculation / Noridianmedicare.com / For lab NOT included in DRG, Per Diem or OPPS/APC
Outpatient Rehabilitation / Fee Schedule / Manual Calculation / Noridianmedicare.com
DME / Fee Schedule / Manual Calculation / Noridianmedicare.com
Mammography / Fee Schedule / Manual Calculation / Noridianmedicare.com
PT,OT,ST / Fee Schedule / Manual Calculation / Noridianmedicare.com