Effective October 7, 2013, TRICARE will reimburse sole community hospitals (SCHs) the higher of the DRG-based amount for inpatient services or an amount approximating the SCH’s costs as determined by applying the most recent Medicare cost-to-charge ratio (CCR) to charges. Labor/delivery and nursery DRGs will be reimbursed 130% of the Medicare CCR. The Medicare CCR used is the sum of Medicare’s operating and capital CCRs so SCHs will not need to file requests for capital cost reimbursement.
P.O. Box 71309
Albany, GA 31708-1309
Phone: 229-883-7878
Fax: 229-435-3152
Five Concourse Parkway, Suite 1250
Atlanta, Georgia 30328
Phone: 404-220-8494
Fax: 229-435-3152
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
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