Low Volume Add-On Payment Instructions for FFY 2012

As discussed in the "Low Volume Add-On Payment" article (available on our "Audit Topics" page), the Low Volume Add-On Payment has been amended for FFY 2011 and FFY 2012. Below is information on the requirements related to the second year (FFY 2012) of this Low Volume Add-On Payment.

Qualifying for FFY 2012 Payments for a hospital that DID NOT apply or qualify for low volume status in FFY 2011

A hospital must make its request for low-volume hospital status in writing to its fiscal intermediary or MAC by September 1, 2011, in order for the applicable low volume percentage add-on to be applied to payments for its discharges beginning on or after October 1, 2011. For any application received after September 1, 2011, the FI/MAC will review the request and the payment will be effective 30 days after the date of the FI/MAC determination. Note that the initial request must consist of documentation supporting that the mileage requirement and the discharge requirements were met. For the mileage requirement, a variety of information, such as Yahoo Maps, Mapquest, or Google Maps will be allowable to show that no other hospitals are 15 miles or closer to the requesting hospital. For the discharge requirement, CMS specifically requires that the MedPar data from table 14 of the IPPS Final Rule be used. No alternative data may be used for the discharge requirement. This table has been linked below.

IPPS Final RuleAdobe Portable Document Format (discussion of the Low Volume Payment begins on page 202)

Table 14 from the FFY 2012 IPPS Final RuleZIP File

Qualifying for FFY 2012 Payments for a hospital that DID apply and qualify for low volume status in FFY 2011

A hospital that qualified for the low-volume payment adjustment in FY 2011 may continue to receive a low-volume payment adjustment in FY 2012, without reapplying, if it continues to meet the Medicare discharge criterion, based on the latest available FY 2010 MedPAR data (as finalized above and shown in Table 14) and the distance criterion.

However, the hospital must "verify in writing" to its fiscal intermediary or MAC that it continues to be more than 15 miles from any other ''subsection (d)'' hospital no later than September 30, 2011. This verification should indicate that the requesting hospital has not moved from its previous location and that no new hospitals have moved into the 15 mile range.

Note that any providers that are currently receiving Low Volume Payments that do not submit the "verification in writing" will be removed from low volume status effective 10/1/2011. If the FFY 2012 request is received after 10/1/2011, and is approved, the low volume status will be reinstated effective 30 days after the date of the approval letter.

Documentation for the Low Volume request should be sent to the following contact:

Wisconsin Physicians Service
Attn: Chris Severson
Medicare Audit Advisement
3333 Farnam Street, Suite 700
Omaha, NE 68131

Or via e-mail at: chris.severson@wpsic.com

Page Last Updated: Friday, 26-Aug-2011 08:30:31 CDT