Over the coming weeks, and most likely months, we will continue to see updates to the FY 2014 Hospital IPPS Final Rule CMS 1599-F in the form of sub-regulatory guidance. As this guidance will come sporadically and in no certain order, it is important that we all try to review, decipher, and stay abreast of this moving target to survive this huge change. CMS issued an update to CMS-Reviewing Hospital Claims for …Read more
On August 2, the Centers for Medicare & Medicaid Services (CMS) published CMS-1599-F, the final rule updating Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS) for the 2014 fiscal year. The final rule also included language addressing the CMS policy on Medicare contractor reviews of short-stay inpatient hospital admissions. Although CMS insisted that the final rule’s …Read more
The two-midnight rule has brought to hospitals not only a lot of confusion, but also a lot of consternation. As we all know, the new rule features a time-based determination of the expectation of length of hospitalization as a determinant of proper status; those patients who are expected to require more than two midnights of care (or having an inpatient-only surgery) are to be admitted as inpatient, and those who …Read more
RAC Region A contractor Performant posted a review issue for Physician/Non-Physician Practitioner provider types regarding Evaluation and Management Coding in Skilled Nursing Facilities. The states listed for this audit issue...Read more
Listeners to RACMonitor’s “Monitor Monday” may have heard the Nov.18 edition that featured Julie Taitsman, MD, JD, chief medical officer of the Office of Inspector General, discussing the OIG’s efforts...Read more
CMS’ long-standing requirement that physicians must “certify” that admissions are appropriate with a valid order and necessary supporting documentation in the medical record are not only outlined in the Code...Read more
On Oct. 1, 2014, the controversial two-midnight rule went into effect. It gives hospitals a small reprieve in the auditing of observation patients that convert to inpatient status. Termed “medically...Read more
Thursday, December 12, 2013, 1:30 p.m. to 2:30 p.m. (ET)
With the release of the 2014 Final Rule for OPPS/ASC, drastic changes are expected for the reporting of implantable medical device credits. Considering the aggressive Office of the Inspector General (OIG) audits targeting facilities (hospitals and ASCs) performing “device-dependent” procedures—combing through years 2008 up to the present...
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