New Technology Add On Payments Thresholds Final Rule

$79 / year

This dataset contains the final rule/correction notice cost thresholds by Medicare Severity Diagnosis Related Group (MS-DRG) for the cost criteria for new technology add on payment applications for applications for FY 2018.

Complexity

Sections 1886(d)(5)(K) and (L) of the Act establish a process of identifying and ensuring adequate payment for new medical services and technologies under the inpatient prospective payment system (IPPS). Section 1886(d)(5)(K)(ii)(I) of the Act specifies that the process must apply to a new medical service or technology if, “based on the estimated costs incurred with respect to discharges involving such service or technology, the DRG prospective payment rate otherwise applicable to such discharges under this subsection is inadequate.” Section 1886(d)(5)(K)(vi) of the Act specifies that a medical service or technology will be considered “new” if it meets criteria established by the Secretary after notice and opportunity for public comment.

Section 412.87(b)(3) provides that, to receive special payment treatment, new technologies meeting this clinical definition must be demonstrated to be inadequately paid otherwise under the DRG system. For applicants for new technology add-on payments for FY 2005 and forward, we established the criteria that will be applied to assess whether technologies would be inadequately paid under the DRGs the lesser of 75 percent of the standardized amount increased to reflect the difference between costs and charges (based on the national case weighted cost-to-charge ratio) or 75 percent of 1 standard deviation (based on the logarithmic values of the charges and transformed back to charges) beyond the geometric mean standardized charge for all cases in the DRGs to which the new technology is assigned (or the case weighted average of all relevant DRGs, if the new technology occurs in many different DRGs).

Date Created

2015

Last Modified

2017-07-31

Version

2017-07-31

Update Frequency

Irregular

Temporal Coverage

NA

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

NA

Source Citation

NA

Keywords

New Medical Services and New Technologies, Medical Services and Technologies, MSGRD Add-On Payments

Other Titles

Add-On Payments Threshold, Drug Related Groups

Name Description Type Constraints
Medicare_Severity_Diagnosis_Related_GroupMedicare Severity-Diagnosis Related Group (MSDRG)string-
Number_Of_CasesNumber of Cases Reportedintegerlevel : Nominal
ThresholdThreshold to Qualify for an Outlier Paymentnumberlevel : Nominal
Medicare_Severity_Diagnosis_Related_GroupNumber_Of_CasesThreshold
79416026
2954330845
5097554618
5999833444
6926645544
7682336396
7779137800
7797323808
7806512477
7829819503