FY 2021 IPPS final rule: Review MS-DRG payment factors and other adjustments

Why This Topic Matters

The article helps readers understand which FY 2021 IPPS changes may affect hospital payment calculations, reimbursement adjustments, and related reporting or program requirements.

Article Sections

1. MS-DRG review

   Introduces the MS-DRG framework used under IPPS and summarizes the broad factors that affect case assignment and reimbursement.

2. Significant MS-DRG/reimbursement changes

   Summarizes selected FY 2021 MS-DRG updates and related reimbursement changes described in the final rule, including changes tied to specific inpatient services and payment treatment in certain circumstances.

3. Additional payment factors

   Provides an overview of the payment components and adjustments that can affect the total MS-DRG payment.

4. OSA

   Reviews operating standardized amounts and the general factors used to determine operating payment updates for FY 2021.

5. Operating adjustments

   Summarizes major operating payment adjustments discussed in the article, including quality, documentation, wage index, and disproportionate share-related factors.

6. Capital standard federal rate

   Describes the FY 2021 capital rate update and the revised capital standard federal rate.

7. Capital adjustments

   Outlines the broad categories of capital payment adjustments that may apply under IPPS.

8. Outlier threshold

   Explains the FY 2021 outlier threshold update and the types of payment amounts considered in the threshold calculation.