Admission Prior to and Discharge After Capital PPS

20.4.9 - Admission Prior to and Discharge After Capital PPS Implementation Date (Rev. 1, 10-01-03) A3-3611.9 The capital payment issued for an inpatient hospital stay that begins prior to and ends after the onset of capital PPS is the amount determined by Pricer for that DRG. No reasonable cost capital pass through payment is payable for the portion of the stay that pre-dates capital PPS. The A/B MAC (A) may not split a bill for the periods before and after the onset of capital PPS that fall into the same billing period. It bases any outlier payment due on the entire stay, not only that portion of the stay that began after the start of capital PPS.