The final Medicare IPPS rule for the federal fiscal year (FFY) 2024 was recently published by CMS and includes the requirements to qualify for the Medicare low-volume inpatient adjustment as the Consolidated Appropriations Act, 2023 has extended the low-volume adjustment definition and payment provisions through FFY 2024. The provisions specify that a hospital qualifies as a low-volume hospital in FFY 2024 if it is more than 15 road miles from another subsection (d) hospital and has less than 3,800 total discharges.
As stated in the FFY 2024 final rule and similar to the requirements in prior years, a hospital receiving the low-volume hospital payment adjustment for FFY 2023 may continue to receive a low-volume hospital payment adjustment for FFY 2024 with a request to the Medicare Administrative Contractor (MAC) by verifying the hospital continues to meet the mileage criteria of more than 15 road miles from another subsection (d) hospital and the total discharge criterion of less than 3,800 total discharges per its most recently submitted Medicare cost report prior to the beginning of FFY 2024. If the hospital is requesting the low-volume adjustment for the first time, it must include sufficient documentation to establish that the hospital meets the applicable mileage and discharge data. For example, the hospital can include a Google Maps image with its application indicating that it meets the mileage requirements to the surrounding subsection (d) hospitals within a certain radius of the hospital.
The low-volume written request needs to be received by the MAC by September 1, 2023 for payments to be applied for its discharges for the FFY beginning October 1, 2023. If a hospital’s written request for low-volume hospital status for FFY 2024 is received after September 1, 2023, and if the MAC determines the hospital meets the criteria to qualify as a low-volume hospital, the MAC would apply the low-volume hospital payment adjustment to determine the payment for the hospital’s FFY 2024 discharges, effective prospectively within 30 days of the date of the MAC’s low-volume hospital status determination.
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