The Bipartisan Budget Act of 2018 extends the relaxed qualifying criteria for the low volume hospital payment adjustment through September 30, 2018. Under the relaxed criteria, the payment increases are applicable for hospitals that have less than 1,600 Medicare discharges (including traditional and Medicare Advantage) and are located more than 15 road miles from another hospital (excluding critical access, psychiatric, rehabilitation, long-term care, cancer, research and children’s hospitals).
For fiscal years 2019 through 2022 the Bipartisan Budget Act of 2018 will reverse the relaxed qualifying criteria. The low-volume payment increases will be applicable for hospitals that have less than 3,800 total discharges and are located more than 15 road miles from another hospital (excluding critical access, psychiatric, rehabilitation, long-term care, cancer, research and children’s hospitals).
For fiscal year 2023 and subsequent fiscal years, the payment adjustment and qualifying criteria revert to the preexisting requirements.
Action Points
CMS instructed MACs in March to notify Hospitals that meet the Medicare discharge criteria of the availability of receiving a low-volume payment adjustment. For any provider who believes that they qualify, they must notify their Medicare Administrative Contractor (MAC) of their desire to receive the adjustment and submit proof that the hospital meets the qualifying mileage requirement. The discharge criteria will be determined by CMS based on MEDPAR data. A provider response is due to the MACs even if the provider previously qualified.
CMS’ deadline to receive a request for this low volume hospital adjustment are forthcoming.
If you need help applying for the adjustment, please contact our Albany office at (229) 883-7878 or our Atlanta office at (404) 220-8494.