Tag Archives: Inpatient hospital

CMS Issues Final FY 2016 Medicare IPPS/LTCH Rule

On July 31, 2015, the Centers for Medicare & Medicaid Services (CMS) released a major final rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and the long-term care hospital prospective payment system (LTCH PPS) for fiscal year (FY) 2016. The official version of the rule will be published in the Federal … Continue Reading

Senate Approves Hospital Outpatient Observation Status “Notice” Act

On July 27, 2015, the Senate approved H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility Act, clearing the measure for the President. H.R. 876 would require hospitals to provide written and oral notification to Medicare beneficiaries receiving observation status for more than 24 hours, rather than admitted as inpatients.… Continue Reading

President Obama Signs MACRA: Permanently Reforms Medicare Physician Reimbursement Framework, Includes Other Health Policy Provisions

Today President Obama signed into law H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.… Continue Reading

CMS Proposed Rules in the Pipeline

CMS recently sent several major proposed rules to the White House Office of Management and Budget for regulatory clearance – the last step before publication in the Federal Register. OMB is reviewing proposed rules to update the skilled nursing facility, inpatient rehabilitation facility, and inpatient psychiatric facility prospective payment systems (PPS) for fiscal year (FY) … Continue Reading

CMS Releases Proposed Medicare Inpatient PPS/LTCH Update for FY 2015

Late on April 30, 2014, CMS released the advance text of its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2015. With regard to IPPS hospitals, the rule would provide for a 1.3% operating payment rate update, … Continue Reading

President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

On April 1, 2014, President Obama signed into law H.R. 4302, the "Protecting Access to Medicare Act of 2014" ("the Act"). The Act includes a one-year Medicare physician fee schedule fix that averts a nearly 24 percent payment cut set for April 1, 2014, but which falls far short of earlier hopes for full repeal of the current sustainable growth rate (SGR) formula. The Act also includes numerous other Medicare payment and policy changes, including skilled nursing facility value-based purchasing provisions, reforms to the physician fee schedule relative valuation process, a new framework for clinical laboratory payments, a variety of changes impacting imaging services, changes in the exceptions for long term care hospitals, and extension of certain expiring provisions. In other areas, the bill includes a one-year delay in the transition to ICD-10, changes to the timetable for Medicaid disproportionate share hospital cuts, and "front-loading" of the 2024 Medicare sequestration reduction.… Continue Reading

MedPAC Issues 2014 Report to Congress on Medicare Payment Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual report to Congress on Medicare payment policy, including payment update recommendations for all the major Medicare fee-for-service payment (FFS) systems, limited recommendations related to the Medicare Advantage (MA) program, and a status report on the Medicare Part D program. The following are highlights of the … Continue Reading

OIG Recommends Expanding the Medicare “DRG Window”

A recent HHS Office of Inspector General (OIG) report examines Medicare services provided during the Medicare Severity Diagnosis Related Group (DRG) payment window – that is, the period when certain outpatient services related to an inpatient admission are considered to be included in the DRG payment. Currently, outpatient services delivered within three days of an inpatient … Continue Reading

CMS Again Extends “Probe & Educate” Phase for 2-Midnight Inpatient Admissions Criteria Implementation; Clarifies Physician Certification Requirements

CMS has announced that it is extending provider education activities related to its new Medicare inpatient hospital admission and medical review criteria (commonly known as the 2-Midnight Rule). Specifically, CMS is extending what it refers to as the “Probe & Educate” review process for an additional six months, through September 30, 2014. Under this extension, … Continue Reading

CMS Guidance on Medicare Inpatient Hospital Admissions Two-Midnight Policy

CMS continues to release subregulatory guidance on the inpatient hospital admission/medical review criteria that were adopted in the final FY 2014 Medicare inpatient prospective payment system/long-term care hospital final rule. In short, under this new policy, if the ordering practitioner expects a beneficiary’s surgical procedure, diagnostic test, or other treatment to require a stay in the … Continue Reading

CMS Call on Inpatient Hospital Admissions 2-Midnight Policy (Nov. 12)

A November 12, 2013 CMS call will focus on the physician order, physician certification, inpatient hospital admission, and medical review criteria that were adopted in the final FY 2014 Inpatient Prospective Payment System/Long-Term Care Hospital final rule. In short, under this new policy, if the ordering practitioner expects a beneficiary’s surgical procedure, diagnostic test or other treatment … Continue Reading

Reed Smith Client Alert on Part B Inpatient Billing in Hospitals

As previously reported, CMS has issued a proposed rule and an Administrator’s Ruling that address the submission of Medicare Part B inpatient claims where a Medicare Part A claim for a hospital inpatient admission is denied by a Medicare review contractor on the grounds that the inpatient admission was not “reasonable and necessary.” A Reed … Continue Reading

MedPAC’s March 2013 Report to Congress

MedPAC has released its annual report to Congress on Medicare Payment Policy, including payment update recommendations for all the major Medicare FFS payment systems and limited Medicare Advantage (MA) recommendations. The report also includes data on the status of the MA and Medicare Part D programs, including information about enrollment, plan options, and beneficiary cost-sharing. … Continue Reading

CMS Updates Hospital Part B Inpatient Billing Policy

This post was also written by Rachel M. Golick. On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) concurrently issued a proposed rule and Administrator’s Ruling addressing the submission of Medicare Part B inpatient claims where a Medicare Part A claim for a hospital inpatient admission is denied by a Medicare review … Continue Reading

CMS Notice Corrects Hospital Readmissions Data

CMS published a notice on March 13, 2013 correcting previous technical errors to the Medicare inpatient prospective payment systems (IPPS) final rulemaking for FY 2013. Among other things, CMS is correcting statistics on the Hospital Readmissions Reduction Program with regard to (1) the amount by which payments to hospitals would be reduced; and (2) the … Continue Reading

CMS Schedules Feb. 5 Meeting on FY 2014 IPPS New Tech Add-on Applications

On February 5, 2013, CMS is holding a town hall meeting on FY 2014 applications for new medical services and technology add-on payments under the hospital inpatient prospective payment system (IPPS). Interested parties are invited to present their recommendations and data regarding whether the FY 2014 new medical services and technologies applications meet the substantial … Continue Reading

CMS Publishes Corrections to FY 2013 IPPS, EHR Incentive Program Final Rules

On October 29, 2012, CMS published additional corrections to its August 31, 2012 final FY 2013 Medicare inpatient prospective payment system (IPPS) rule. The corrections address the achievement thresholds and benchmark values presented in the Clinical Process of Care measures section of the final performance standards for the FY 2015 Hospital Value-Based Purchasing Program table.  … Continue Reading

CMS Publishes Corrections to Administrative Simplification, IPPS/LTCH PPS Rules

On October 4, 2012, CMS published technical corrections to the agency’s September 5, 2012 final administrative transactions rule that adopted a unique health plan identifier standard and delayed the implementation date for the International Classification of Diseases, 10th Revision (ICD-10) coding update from October 1, 2013 to October 1, 2014. CMS also published a rule … Continue Reading

CMS Issues Final Medicare Inpatient Hospital Rates/Policies for FY 2013

On August 31, 2012, the Centers for Medicare & Medicaid Services (CMS) is publishing its final rule to update Medicare inpatient prospective payment system (IPPS) hospital and long-term care hospital prospective payment system (LTCH-PPS) payment and other policies for FY 2013. Overall, CMS estimates that FY 2013 payments to general acute care hospitals for operating … Continue Reading

CMS Correction Notices (IPPS, LTCH-PPS, MA, PDP)

On June 11, 2012, CMS published corrections to the May 11, 2012 proposed rule to update Medicare inpatient prospective payment system (IPPS) hospital and long-term care hospital prospective payment system (LTCH-PPS) payment and other policies for fiscal year (FY) 2013. Among other things, CMS is decreasing the national capital standard federal payment rate, which in … Continue Reading

Medicare Payments for Outpatient Services Before/During Inpatient Stay

The OIG has issued a report entitled “Medicare Continues To Pay Twice for Nonphysician Outpatient Services Provided Shortly Before or During an Inpatient Stay.” The OIG estimates that Medicare contractors made approximately $6.4 million in overpayments to hospital outpatient providers in 2008 and 2009 for services provided to beneficiaries within 3 days prior to or … Continue Reading

Medicare Trends in Implantable Medical Device (IMD) Procedures

The Government Accountability Office (GAO) has issued a report entitled “Medicare: Trends in Beneficiaries Served and Hospital Resources Used in Implantable Medical Device Procedures.”  The report discusses trends in the use of IMD procedures – particularly orthopedic and cardiac implants — among Medicare beneficiaries from the period of 2003 to 2009. The report includes data regarding, … Continue Reading
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