Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 12/31/14

Updates to Hospital Medicare Inpatient Prospective Payment System (IPPS) Outlier Cost to Charge Ratios

 

​To: ​Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers
Date:​ December 31, 2014​
​Re: ​Updates to Hospital Medicare Inpatient Prospective Payment System (IPPS) Outlier Cost to Charge Ratios

In accordance with 89 IL Admin Code 149.105(b), the department is updating the Medicare inpatient prospective payment system (IPPS) outlier cost to charge ratios for those hospitals reimbursed under the APR-DRG payment system. Effective with discharges on or after January 1, 2015:

  • For Medicare IPPS hospitals, the outlier cost-to-charge ratio is based on the sum of the Medicare inpatient prospective payment system hospital-specific operating and capital outlier cost-to-charge ratios effective at the beginning of the federal fiscal year starting three months prior to the calendar year during which the discharge occurred.

  • For non-Medicare IPPS hospitals, the outlier cost-to-charge ratio is based on the sum of the Medicare inpatient prospective payment system statewide average operating and capital outlier cost-to-charge ratios for urban hospitals for the state in which the hospital is located, effective at the beginning of the federal fiscal year starting three months prior to the calendar year during which the discharge occurred.

For those hospitals affected, new rate sheets have been posted to the department’s website: Hospital Rate Sheets Effective January 1, 2015. Hospitals can access their rate sheet by clicking on the appropriate link at that site. The cost to charge ratios are the only updates to these rate sheets.

Per 89 IL Admin Code 148.310(f), hospitals can appeal the accuracy of the updated cost to charge ratios through a written request for review that must be submitted in writing and must either be received by the department, or post marked within 30 days after the date of this notice. Therefore, the deadline for appeals is January 30, 2015. Please direct all appeals and supporting documentation to:

 

Illinois Department of Healthcare and Family Services

Bureau of Rate Development and Analysis

Attn: Appeals

201 South Grand Avenue East, 2nd Floor

Springfield, Illinois 62763

 

If you have any further questions in regards to this notice, please contact the Bureau of Rate Development and Analysis at 217-785-0710.

 

Sincerely,

 

 

Dan Jenkins, Chief

Bureau of Rate Development and Analysis