...Hospital Reimbursement – Differences Between Medicare and BWC The two tables below provide a summary of areas where the Ohio Bureau of Workers’ Compensation (BWC) differs from Medicare for reimbursement of hospital inpatient and outpatient services. Use this document as supplemental material to support Ohio Administrative Code Rule 4123-6-37 Payment .1, of Hospital Inpatient Services, and Rule 4123-6-37 Payment of Hospital Outpatient Services, for the .2, effective dates specified at the beginning of each table. 4123-6-37.1 Payment of Hospital Inpatient Services Effective for Discharge Dates from Feb. 1, 2011, to Jan. 31, 2012 Area Payment adjustment factors Medicare 100 percent of the Medicare rate (Includes both the Medicare portion and the beneficiary portion) BWC • 120 percent of inpatient • • • prospective payment system (IPPS) rate for inliers (non-outlier bills). 180 percent of IPPS rate for outliers Additional 0.25 percent adjustment to restore Medicare’s market basket adjustment Additional 2.9 percent adjustment to restore Medicare’s documentation and coding adjustment Hospital acquired conditions (HACs) provision Reduces IPPS payments when hospitals meet the HAC criteria Excludes the HAC provision Direct graduate medical education per diem (DGME) Does not provide DGME per diem payments under IPPS Provides a per diem add-on payment for DGME for eligible providers Does not reduce IPPS payments Does not apply DGME per diem addon payments to outlier bills...
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