51         219-240    X(22)         Filler             Blank.
Payment Rate       above.)
Exception          which a hospital is entitled. (See §20.4.7
50         213-218    9(4)V9(2)     Capital            The per discharge exception payment to
hospital.
for IRFs.) Zero-fill for a non-teaching
hospital and §§140.2.4.3 and 140.2.4.5.1
days. (See §20.4.1 for inpatient acute
fiscal year by the hospital's total inpatient
equivalent total of residents during the
by dividing the hospital's full-time
Education Ratio    hospital's average daily census. Calculate
Medical            Enter the ratio of residents/interns to the
49         208-212    9V9(4)        Capital Indirect   This is for IPPS hospitals and IRFs only.
operation.
hospital is not within first 2 years of
hospital is in operation. Leave blank if
48         207        X(1)          New Hospital       Enter "Y" for the first 2 years that a new
LTCH Prospective Payment Systems.
CCR for Acute Care Hospital Inpatient and
methodology to be used to determine the
See below for a detailed description of the
agrees the hospital's rate is justified.
Element    Position
Data       File       Format        Title              Description
ratio rather than the statewide average if it
deviation band. The FI uses the hospital's
charge ratio that lies outside a 3 standard
submit evidence to justify a capital cost-to-
in the "Federal Register." A provider may
calculated annually by CMS and published
statewide average cost-to-charge ratio
charge ratio, it uses the appropriate
unable to compute a reasonable cost-to-
file. For hospitals for which the FI is
Charge Ratio      corresponding charge data from the billing
47        203-206    9V9(3)      Capital Cost-to- Derived from the latest cost report and
costs. Update annually.
Ratio             hospital's total allowable inpatient capital
Hold Harmless     inpatient costs for new capital to the
46        198-202    9V9(4)      New Capital-      Enter the ratio of the hospital's allowable
1990, for capital PPS. Update annually.
for assets acquired before December 31,
Harmless Rate     "old" capital costs per discharge incurred
45        192-197    9(4)V9(2)   Old Capital Hold Enter the hospital's allowable inpatient
This field is not used as of 10/1/02.
year inpatient capital costs per discharge.
Enter the hospital's allowable adjusted base
Termination Date field.
• A termination date is present in
Type field; or
• A“08” is entered in the Provider
field; or
Indirect Medical Education Ratio
Capital Rate           • A "Y" is entered in the Capital
44        186-191    9(4)V9(2)   Hospital Specific Must be present unless:
C = Fully prospective blended rate
B = Hold Harmless – 100% Federal rate
capital
A = Hold Harmless – cost payment for old
Payment Code      capital payment methodology for hospitals:
43        185        X(1)        Capital PPS       Enter the code to indicate the type of
Zero-fill if this does not apply.
Clotting Factors, or DSH adjustments.
Indirect Medical Education, Hemophilia
program. Do not include amounts paid for
conducted by a provider in an approved
Health Professional Education when
surgeries per year, and Nursing and Allied
Element   Position
Data      File       Format      Title              Description
hospitals that perform fewer than 500
Miscellaneous Pass Through for rural
Anesthetists (CRNAs) are paid as part of
amounts. Certified Registered Nurse
addition to the above pass through
included in total pass through amount in
Miscellaneous    amounts listed above. The following are
Including        at least equal to the three pass through
Amount,          Reimbursement Manual §2405.2.) Must be
Through          payments to the hospital (See the Provider
42        179-184    9(4)V9(2)   Total Pass       Per diem amount based on the interim
fill if this does not apply.
Reimbursement Manual, §2405.2.) Zero-
marrow transplants. (See the Provider
Do not include acquisition costs for bone
Acquisition      pancreas, intestine and liver transplants.
Organ            acquisition amounts for kidney, heart, lung,
Amount for       payments to the hospital. Include standard
41        173-178    9(4)V9(2)   Pass Through     Per diem amount based on the interim
Education        fill if this does not apply.
Direct Medical   Reimbursement Manual, §2405.2.). Zero-
Amount for       payments to the hospital (See the Provider,
40        167-172    9(4)V9(2)   Pass Through     Per diem amount based on the interim
apply.
hospitals or units. Zero-fill if this does not
operation FY 92 or later, and non-PPS
hospitals during their first 2 years of
reporting period beginning in FY 92, new
for PPS hospitals prior to their cost
Reimbursement Manual, §2405.2). Used
Capital          location 185 = A, B, or C (See the Provider
Amount for       payments to the hospital. Must be zero if
39        161-166    9(4)V9(2)   Pass Through     Per diem amount based on the interim
equals a “1” or “2.”
unless the Special Payment Indicator field
Index            providers may be assigned. Enter zeroes
38        155-160    9(2)V9(4)   Special Wage     Enter the special wage index that certain
CBSA if this field is left blank
automatically default to the actual location
35) if not reclassified. Pricer will
or enter the actual location CBSA (field
hospital has been reclassified. Leave blank
such as _ _ _ 3 6 for Ohio, to which a
Data      File       Format      Title            Description
Location CBSA      (blank)(blank) (2 digit numeric State code)
Amount             00001-89999 or the rural area, (blank)
37        150-154    X(5)     Standardized       Enter the appropriate code for the CBSA,
CBSA if this field is left blank.
35), if not reclassified. Pricer will
to its prevailing wage rates. Leave blank
which a hospital has been reclassified due
State code) such as _ _ _ 3 6 for Ohio, to
(blank)(blank) (blank) (2 digit numeric
Location CBSA      00001-89999, or the rural area,
36        145-149    X(5)     Wage Index         Enter the appropriate code for the CBSA,
(CBSA)
Statistical Area   facility is physically located.
Core-Based         such as _ _ _ 36 for Ohio, where the
Location           (blank) (blank) 2 digit numeric State code
Geographic         00001-89999, or the rural area, (blank
35        140-144    X(5)     Actual             Enter the appropriate code for the CBSA
met
1 = hospital quality standards have been
Blank = hospital does not meet criteria
MMA quality standards.
Indicator          criteria to receive higher payment per
34        139        X(1)     Hospital Quality   Enter code to indicate that hospital meets
reclassified
2 = both special wage index indicator and
1 = special wage index indicator
Y = reclassified
Blank = not applicable
Indicator          special payment provision that applies.
33        138        X(1)     Special Payment    Enter the code that indicates the type of
must be CCYYMMDD.
32        130-137    9(8)     Fiscal Year End    This field is no longer used. If present,
later.
field. Zero-fill for all hospitals 10/1/91 and
DSH effective 10/1/91 and bypasses this
Percentage. Pricer calculates the Operating
31        126-129    V9(4)    Operating DSH      Disproportionate share adjustment
Update Factor      Field is obsolete as of FY92.
30        120-125    9V9(5)   Special Provider   Zero-fill for all hospitals after FY91. This
Period             Blank for periods on or after 4/1/91.
29        119        X(1)     Provider PPS       This field is obsolete as of 4/1/91. Leave
Data      File       Format   Title              Description
operating DSH adjustments.
determine the size of the capital and
disproportionate share adjustment and to
if the hospital qualifies for a
28        115-118    V9(4)    Medicaid Ratio    Enter the Medicaid ratio used to determine
adjustments.
of the capital and operating DSH
Ratio             share adjustment and to determine the size
Security Income   hospital qualifies for a disproportionate
27        111-114    V9(4)    Supplemental      Enter the SSI ratio used to determine if the
compared to the national average mix.
relative cost of that hospital's mix of cases
on 1981 cost and billing data) reflecting the
published by CMS for each hospital (based
index that has been calculated and
others. In most cases, this is the case mix
positions 81-87 (field 21). Zero-fill for all
26        106-110    9V9(4)   Case Mix Index    The case mix index is used to compute
more recent data for determining CCRs.
See below for a discussion of the use of
entered here.
operating and capital cost-to-charge ratio is
For LTCH and IRF PPS, a combined
Register."
within the limits published in the "Federal
compute cost-to-charge ratios that are not
payments for those hospitals where you
ratios are used to calculate cost outlier
in the "Federal Register." These average
they use the appropriate urban or rural
compute a reasonable cost-to-charge ratio,
hospitals for which the FI is unable to
the FI billing file, i.e., PS&R record. For
53. Obtain Medicare covered charges from
Supplemental Worksheet D-1, Part II, Line
Medicare cost repot form CMS-2552-96,
Medicare operating costs from the
Medicare covered charges. Obtain
dividing the Medicare operating costs by
billing file. Compute this amount by
to Charge Ratio   and corresponding charge data from the
25        102-105    9V9(3)   Operating Cost    Derived from the latest settled cost report
Data      File       Format   Title             Description
§2405.3G.)
the Provider Reimbursement Manual,
inpatient. Must be greater than zero. (See
pediatric beds available for lodging
24        97-101     9(5)     Bed Size         Enter the number of adult hospital beds and
daily census.
residents/interns to the hospital’s average
IPF PPS: Enter the ratio of
Enter zero for non-teaching hospitals.
of the cost reporting period.
necessary changes in the count at the end
for reviewing hospital records and making
particular facility. The FI is responsible
the count is substantially in error for a
cases where there is reason to believe that
hospital during the fiscal year. Correct
equivalent residents assigned to the
count upon the average number of full-time
assigned to PPS excluded units. Base the
employed to replace anesthetists or those
residents in anesthesiology who are
in positions 97-101). Do not include
the number of available beds (as calculated
provider's full time equivalent residents by
Ratio            ratio. Calculate this by dividing the
23        92-96      9V9(4)   Intern/Beds      Enter the provider's intern/resident to bed
(COLA)
Adjustment       Alaska and Hawaii use 1.000.
22        88-91      9V9(3)   Cost of Living   Enter the COLA. All hospitals except
if figure is greater than $35,000.
Data      File       Format   Title            Description
is greater than $10,000. For LTCH, verify
For inpatient PPS hospitals, verify if figure
Rate                dependent hospitals on or after 04/01/90.
Facility Specific   §20.1 for sole community and Medicare-
Discharge/PPS       index. Enter zero for new providers. See
Per                 per discharge divided by the case mix
Adjusted Cost       excluded hospitals, enter the base year cost
21        81-87      9(5)V9(2)   Case Mix            For PPS hospitals and waiver state non-
20        78-80      X(3)        Filler              Blank.
100-07, Chapter 2, Section 2779A1.
List of valid state codes is located in Pub.
a “10” for Florida’s state code.
State Codes: 10, 68 and 69. FIs shall enter
October 1, 2005, Florida has the following
for a given state. For example, effective
located. Enter only the first (lowest) code
19        76-77      9(2)        State Code          Enter the 2-digit state where the provider is
4               100             00
3               75              25
2               50              50
1               25              75
Federal %       Facility%
1/1/2005.
cost reporting periods beginning on or after
rates. Effective for all IPF providers with
the blend ratio between federal and facility
IPF PPS: Enter the appropriate code for
5               100             00
4               80              20
3               60              40
2               40              60
1               20              80
beginning on or after 10/01/2002.
providers with cost reporting periods
facility rates. Effective for all LTCH
for the blend ratio between federal and
LTCH PPS: Enter the appropriate code
10/01/2002.
IRF PPS: All IRFs are 100% Federal for
1 = Pay zero percent
0 = Pay standard percentages
Data      File       Format      Title               Description
10/01/2000
HHA providers, effective on or after
on HH PPS RAPs. Must be present for all
Blend Indicator    appropriate percentage payment to be made
18        75         X(1)     Federal PPS        HH PPS: Enter the code for the
DataFiles.asp#TopOfPage
www.cms.hhs.gov/InpatientRehabFacPPS/07_
following website:
47880). The table can also be found at the
August 15, 2005 Federal Register (70 FR
county in Table 2 of the Addendum of the
a “Y” for IRFs located in the state and
IRF PPS: Effective October 1, 2005, code
Emergency Department.
the freestanding psych facility has an
located has an Emergency Department or if
a “Y” if the acute facility where the unit is
IPF PPS: Effective January 1, 2005, code
volume.”
“Y” if the provider is considered “low
IPPS: Effective October 1, 2004, code a
provision, otherwise leave blank.
Relief Indicator   payment update under the temporary relief
17        74         X(1)     Temporary          Enter a “Y” if this provider qualifies for a
been a Lugar reclassification.
Leave blank for hospitals if there has not
wage index MSA.
qualifies for payment under an alternate
on an outpatient basis when a hospital
apply to ASC-approved services provided
known as Lugar reclassifications, and
reclassification   §1886(d)(8)(B) of the Act. These are also
Lugar              reclassified for wage index purposes under
16        73         X(1)     Change Code for    Enter an "L" if the MSA has been
the Federal rate.
or 87, even if the hospital will be paid at
for any SCH or MDH that operated in 82
82 or 87. See §20.6. Must be completed
hospital specific rate, the higher of either
show the base year for the operating
Year               April 1, 1990. If an SCH or an MDH,
Hospital – Base    reporting periods that begin on or after
Dependent          hospital (MDH) effective with cost
or Medicare        hospital (SCH) or a Medicare dependent
15        71-72      X(2)     Sole Community     Leave blank if not a sole community
location MSA if this field is left blank.
will automatically default to the actual
MSA (field 13) if not reclassified. Pricer
Leave blank or enter the actual location
been reclassified for standardized amount.
_ _ 3 6 for Ohio, to which a hospital has
Location           (blank) (2 digit numeric State code) such as
Amount MSA         0040-9965, or the rural area, (blank)
14        67-70      X(4)     Standardized       Enter the appropriate code for the MSA,
blank.
actual location MSA if this field is left
Pricer will automatically default to the
location MSA (field 13), if not reclassified.
rates. Leave blank or enter the actual
been reclassified due to its prevailing wage
(blank) (2 digit numeric State code) such as
Location - MSA     0040-9965, or the rural area, (blank)
13        63-66      X(4)     Wage Index         Enter the appropriate code for the MSA,
physically located.
_ _36 for Ohio, where the facility is
Location - MSA     (blank) 2 digit numeric State code such as
Geographic         0040-9965, or the rural area, (blank)
12        59-62      X(4)     Actual             Enter the appropriate code for the MSA
year. Adjust annually.
Reclassification   "N" if it has not been reclassified for the
Wage Index         has been reclassified for the year. Enter
11        58         X(1)     Change Code        Enter "Y" if hospital's wage index location
new standardized amount location.
changes the census division to reflect the
purposes of the standard amount, the FI
NOTE: When a facility is reclassified for
9 Pacific
8 Mountain
7 West South Central
6 West North Central
5 East South Central
4 East North Central
3 South Atlantic
2 Middle Atlantic
1 New England
location. Valid codes are:
reflect the new standardized amount
FIs must change the census division to
reclassified for the standardized amount,
payment purposes. When a facility is
Division         division to which the facility belongs for
10        57         9(1)     Current Census   Must be numeric (1-9). Enter the Census
unit-to-provider type cross-walk).
OSCAR number (See field #2 for a special
assigned to the third position of the
to special unit designations that are
NOTE: Provider Type values 49-54 refer
54 Critical Access Hospital – Swing Bed
53 Rehabilitation Facility – Swing Bed
52 Long-Term Care Hospital – Swing Bed
51 Short-Term Hospital – Swing Bed
50 Rehabilitation Distinct Part
49 Psychiatric Distinct Part
48 Outpatient Physical Therapy Services
47 Community Mental Health Centers
Facilities
46 Comprehensive Outpatient Rehab
45 Rural Health Clinics-Provider Based
44 Rural Health Clinics-Free Standing
Institutions
43 Religious Non-Medical Health Care
42 Federally Qualified Health Centers
41 Independent ESRD Facility
40 Hospital Based ESRD Facility
after July 1, 1998
cost reporting periods beginning on or
non-demo PPS SNFs – effective for
38 Skilled Nursing Facility (SNF) – For
37 Critical Access Hospital
36 Home Health Agency
35 Hospice
34 Reserved
Project – Phase III – Step 1
33 Nursing Home Case Mix Quality Demo
Project – Phase II
32 Nursing Home Case Mix Quality Demo
23 Rural Primary Care Hospital
Hospital/Referral Center
22 Essential Access Community
21 Essential Access Community Hospital
18 Medical Assistance Facility
Referral Center
17 Re-based Sole Community Hospital/
16 Re-based Sole Community Hospital
1997).
October 1, 1994 through September 30,
began on or after April 1, 1990. Invalid
(during cost reporting periods that
Center
15 Medicare Dependent Hospital/Referral
began on or after April 1, 1990).
14 Medicare Dependent Hospital
13 Cancer Facility
08 Indian Health Service
07 Rural Referral Center
provider types: 49, 50, 51, 52, 53, or 54)
hospital distinct part as one of the following
no longer be used. Instead, FIs will assign a
2006. At that point, provider type “06” will
(Provider type “06” is effective until July 1,
06 Hospital Distinct Parts
05 Pediatric
04 Rehabilitation Facility
03 Psychiatric
02 Long Term
00 or blanks = Short Term Facility
following codes as appropriate.
special handling. Enter one of the
9         55-56      X(2)     Provider Type   This identifies providers that require
Number
8         50-54      9(5)     Intermediary    Assigned intermediary number.
Data      File       Format   Title           Description
N = not waived (Provider is under PPS).
Y = waived (Provider is not under PPS).
7         49         X(1)     Waiver Indicator   Enter a “Y” or “N.”
identification number.
transmitted to CO for the old provider
termination date in the PROV file
number changes, the FI must place a
Likewise, if the provider identification
provider was serviced by the outgoing FI.
in the file to reflect the last date the
to another FI, a termination date is placed
If the provider is terminated or transferred
greater than the effective date.
termination date. Must be equal to or
the provider. Must be zeros or contain a
on which the reporting FI ceased servicing
Date               Termination Date in this context is the date
6         41-48      9(8)     Termination        Must be numeric, CCYYMMDD.
report for submittal to CMS CO.
Date file created/run date of the PROV
5         33-40      9(8)     Report Date        Must be numeric, CCYYMMDD.
effective date.
date. Must be equal to or less than the
blended payment based on their FY begin
current year for providers receiving a
Must be updated annually to show the
Day: 01-31
Month: 01-12
current year.
Beginning Date     Year: Greater than 81, but not greater than
4         25-32      9(8)     Fiscal Year        Must be numeric, CCYYMMDD.
Year: Greater than 82, but not greater than
or less than the termination date.
record, the effective date must be equal to
file. If a termination date is present for this
effective date of a change to the PROV
period, or for subsequent PPS periods, the
the effective date of the provider's first PPS
3         17-24      9(8)     Effective Date     Must be numeric, CCYYMMDD. This is
Z - SB for CAHs                54
Y - SB for Rehab               53
W - SB for LTCH                52
U - SB for short-term hosp.    51
T - Rehab Unit                 50
S - Psych Unit                 49
R - Rehab unit in CAH          50
M - Psych unit in CAH          49
Type
Special Unit                   Prov.
bed):
type, as shown below (NOTE: SB = swing
correspond to the appropriate provider
position of the OSCAR number and should
Codes for special units are in the third
70-84, 90-99           36
15-17                  35
50-64                  32-34, 38
40-44                  03
33                     05
30                     04
20-22                  02
13                     23,37
12                     18
13-17, 21-22
00-08                  Blanks, 00, 07-11,
Provider #           Provider Type
Positions 3 and 4 of:
No.                number. Cross check to provider type.
2         11-16      X(6)         Provider Oscar     Alpha-numeric 6 character provider
Identifier (NPI)
Provider
1         1-10       X(10)        National           Alpha-numeric 10 character NPI number.
Data      File       Format       Title              Description
(Rev. 817, Issued: 01-20-06, Effective: 04-01-06, Implementation: 04-03-06)
Addendum A - Provider Specific File
Operating Disproportionate Share Adjustment (DSH) Percentage (Not Used as of 10/1/91)
For example, FY2000 begins 1999-10-01 and ends 2000-09-30
October 1 is the beginning of the next fiscal year
467 values of fye are not formatted correctly as CCYYMMDD numbers.
3 values of fyb are not formatted correctly as CCYYMMDD numbers.
Source Text File: HOS_psf1707.txt
Source File URL: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/Downloads/HOS-PSF.zip
Source Page: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS-Regulations-and-Notices-Items/CMS1184306.html
psfhos set up by Jean Roth , jroth@nber.org , 17 Feb 2018