Negotiated Rate based on CMS Inpatient Psychiatric Facility PPS : Per-Diem + DRG + Comorbidities + Age + Length of Stay Adjustment #409
Description
The In-Network Schema does not support (an upcoming commercial adaptation of) the CMS Inpatient Psychiatric Facility PPS.
For reference see this document
A hybrid DRG/Per-Diem rate is multiplied by a "DRG Adjustment", a length of stay based "Variable Per Diem Adjustment", an adjustment for "Facility With a Qualifying Emergency Department", a patient "Age Adjustment", and by 17 different "Comorbidity Adjustments".
Walking it through:
"Negotated Type" : "Derived"
"Additional Information" "Revised CMS Inpatient Psychiatric Facility PPS"
"Billing Code Type" : "DRG"
But how to break out the comorbidities, age, and length of stay? Only think I can think of is re-purposing the Negotiated Price Object's "billing_code_modifier" to contain a new code set representing every permutation of Length of Stay Range + Age Range + Comorbidity, but things are complicated by the fact that a Commercial adaptation will deviate from the CMS specification, e.g. proving a separate pediatric age range and adding or changing comorbidity definitions.