The Centers for Medicare & Medicaid Services (CMS) has released the Fiscal Year (FY) 2025 final rule, providing crucial updates to Medicare payment policies and rates for healthcare facilities, including Long-Term Care Hospitals (LTCHs). These updates directly impact Long Term Acute Care Coding Guidelines and how healthcare providers should approach medical coding and billing in these specialized settings. This article breaks down the key aspects of this final rule and its implications for accurate coding practices.
The FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (CMS-1808-F) brings essential changes for LTCHs. For a comprehensive overview of the key provisions, you can refer to the CMS fact sheet summarizing these updates (summary of key provisions). Understanding these summaries is the first step in adapting your long term acute care coding guidelines.
Legislative Background of LTCH Prospective Payment System
The foundation of the LTCH Prospective Payment System (PPS) lies in legislative acts such as the Balanced Budget Refinement Act of 1999 (BBRA) and the Benefits Improvement and Protection Act of 2000 (BIPA). These acts established the framework for Medicare Part A payments for LTCH inpatient stays, based on prospectively set rates. The LTCH PPS, effective for cost reporting periods starting on or after October 1, 2002, applies to hospitals with an average inpatient length of stay greater than 25 days, as defined in section 1886(d)(1)(B)(iv) of the Social Security Act.
Amendments over the years, including the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) and the 21st Century Cures Act, have further refined the definition and categorization of LTCHs and similar facilities. Notably, the 21st Century Cures Act led to the re-designation of certain hospitals as “Extended Neoplastic Disease Care Hospitals,” separating them from the LTCH PPS. Coders working with long term acute care coding guidelines need to be aware of these distinctions to ensure accurate classification and billing.
Quality Reporting Program and its Impact on Coding
Section 3004 of the Affordable Care Act mandated the establishment of quality reporting requirements for LTCHs, along with Inpatient Rehabilitation Facilities (IRFs) and Hospice Programs. The Quality Reporting Programs for LTCHs, IRFs, and Hospices page provides detailed information on these programs.
These quality reporting programs are integral to long term acute care coding guidelines because accurate coding is essential for capturing and reporting quality measures. The data derived from coded medical records is used to assess the quality of care provided in LTCHs and impacts reimbursement. Therefore, staying updated with the FY 2025 final rule and related quality reporting requirements is crucial for coding professionals in long-term acute care settings.
Conclusion
The FY 2025 Final Rule for Inpatient and Long-Term Care Hospitals contains vital updates that directly influence long term acute care coding guidelines. Understanding the changes to the LTCH PPS, the legislative background, and the quality reporting program requirements is paramount for accurate medical coding, compliant billing, and ultimately, for the financial health of LTCH facilities. Healthcare professionals involved in coding and billing for LTCHs must stay informed about these evolving regulations to ensure adherence and optimize their coding practices.
For further information and resources, visit the Hospital Center for a centralized hub of information for Medicare Fee-for-Service hospitals.
