3.2 Calculation Of The ASA
The TRICARE ASA is calculated
as follows:
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. Increase, the base standardized
amount 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, compute a non-teaching standardized amount 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
amount 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 January
1, 2026, for wage index values greater than 1.0, the
labor related portion of the ASA shall equal 67.6 66.0%,
and the non-labor related portion shall equal 32.4 34.0%.
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.
