3.2 Calculation
Of The ASA
The following
procedures are followed in calculating the TRICARE ASA.
3.2.2 Increase for Bad Debts
The base standardized amount
is increased by 0.01 to reimburse hospitals for bad debt expenses attributable
to TRICARE beneficiaries. Effective FY 2013, the base standardized
amount will be increased by 0.0065.
3.2.3 Update
for Inflation
Any recalculation
of the ASA uses an inflation factor equal to the hospital market
basket index used by the Centers for Medicare and Medicaid Services
(CMS) in their Inpatient Prospective Payment System (IPPS).
3.2.4 Preliminary Non-Teaching Standardized
Amount
At this
point Indirect Medical Education (IDME) costs have been removed
through standardization in the weight methodology and direct medical
education costs have been removed through the application of the
Medicare CCR which does not include direct medical education costs.
Therefore, a non-teaching standardized amount is computed by dividing
aggregate costs by the number of discharges in the database.
3.2.5 Preliminary Teaching Standardized
Amounts
A separate
standardized amount is calculated for each teaching hospital to
reimburse for IDME expenses. This is done by multiplying the non-teaching
standardized amount by 1.0 plus each hospital’s IDME factor.
3.2.6 System Standardization
The preliminary standardized
amounts is further standardized using a factor which equals total
DRG payments using the preliminary standardized amounts divided
by the sum of all costs in the database (updated for inflation).
To achieve standardization, each preliminary standardized amount
is divided by this factor. This step is necessary so that total
DRG system outlays, given the same distribution among hospitals
and diagnoses, are equal whether based upon DRGs or on charges reduced
to costs.
3.2.7 Labor-Related
and Non-Labor-Related Portions of the ASA
The ASA shall be divided into
labor-related and nonlabor-related portions according to the ratio
of these amounts in the national ASA under the Medicare IPPS. Effective
October 1, 2013, and subsequent years, for wage index values greater
than 1.0, the labor related portion of the ASA shall equal 68.3% 67.3%,
and the non-labor related portion shall equal 31.7% 32.7%.
For wage indexes less than or equal to 1.0 the labor-related portion
for the ASA shall equal 62% and the non-labor-related portion shall equal
38%.
3.2.8 Updating the Standardized Amounts
For years subsequent to the
initial year, the standardized amounts is updated by the final published Medicare
annual update factor, unless the standardized amounts are recalculated.