How a Wage Index Error Travels Through Five Rate Books
CMS corrected two more FY 2027 payment rules this morning, both traced to the single hospital record that forced Tuesday's inpatient correction. Hospice got recalculated rates, a reissued contractor instruction and a wage index file republished on Tuesday. Skilled nursing got recalculated rates and a wage index file on cms.gov still stamped July 29. Inpatient rehab and inpatient psych price off the same index and have no correction at all, with the fiscal year opening Thursday.
If you run a skilled nursing facility or a hospice, the FY 2027 rate you modeled in August is wrong, and CMS told you so this morning.
Two correcting documents publish in today's Federal Register. CMS-1843-CN runs 18 pages as filed against the SNF PPS final rule of July 31.
CMS-1851-CN runs 9 against the hospice rule of August 3.
Both were filed to public inspection Tuesday at 8:45 a.m., one day and zero minutes behind the inpatient correction we took apart yesterday. Both take effect Thursday, which is the day the fiscal year they price begins.
And both name the same hospital.
One Provider Record, Five Rate Books
CCN 250078 is a current IPPS hospital that CMS treated as one that had converted to rural emergency hospital status. That pulled its wage data out of the FY 2027 IPPS pre-floor, pre-reclassified wage index.
Four other FY 2027 payment systems buy that index wholesale, in their own words:
- SNF PPS: "the updated, pre-reclassified, hospital inpatient PPS (IPPS) wage data, exclusive of the occupational mix adjustment, omitting the rural floor."
- Hospice: "the FY 2027 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) pre-floor, pre-reclassified wage index."
- IRF PPS: "the FY 2027 pre-reclassification and pre-floor hospital wage index data."
- IPF PPS: "the unadjusted, pre-floor, pre-reclassified IPPS hospital wage index."
Since FY 2020 all four have used the index from the fiscal year concurrent with their own, which the IPF rule spells out and attributes to hospice, IRF and SNF in the same paragraph.
So one provider record priced five rate books. Restoring it means recalculating all five.
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