Inpatient Billing

News & Analysis as of

Does Medicare NOTICE Bill Miss the Point?

The bill would require hospitals to give meaningful notice to patients who have been assigned “observation” status for over 24 hours. Observation status is different from inpatient status under the rules of Medicare and other...more

Medicare Patients Caught In Two-Midnight Rule Crossfire

Hospitals have been complaining about the two-midnight rule since it was first announced. But mounting evidence indicates that Medicare patients themselves are suffering badly from the effects of the rule....more

Newly Released CMS Actuary’s Report Confirms CMS Ignored Impact of Two Midnight Rule on Medical Admissions When Setting 0.2...

On June 30, 2014, King & Spalding filed comments in response to Medicare’s proposed IPPS rule for Fiscal Year (FY) 2015 on behalf of more than 200 hospitals it represents in a federal court challenge to the FY 2014 Two...more

OIG Says Medicare Overpaid Hospitals by $19 Million for Claims Subject to the Post-Acute Care Transfer Policy

On May 28, 2014, OIG released a report asserting that over $19 million in inappropriate payments were made to hospitals for inpatient claims subject to the post-acute care transfer policy. These overpayments were the result...more

Second Circuit Dismisses $50 Million FCA Suit

Last week, the United States Court of Appeals for the Second Circuit affirmed the dismissal of a False Claims Act (“FCA”) whistleblower suit seeking $50 million in damages from Huron Consulting Group Inc. (“Huron”) for...more

CMS Joins In Bashing The Two-Midnight Rule

Hospitals hate it. Doctors hate it. Congress hates it so much it required CMS to delay audits of compliance until next year. Then yesterday CMS Deputy Administrator Sean Cavanaugh, testifying before a House Committee...more

IPPS Proposed Rule: Read Once, Then Take an Aspirin

The Centers for Medicare and Medicaid Services (CMS) has set its sights on the quality of care during hospital inpatient stays and much, much more. On May 15, 2014, CMS published a proposed rule that would update Medicare...more

CMS Extends the Two-Midnight “Probe & Educate” Period and Releases Additional Guidance Related to the Admission Order and...

On Friday, January 31, 2014, CMS announced it would extend the “Probe & Educate Period,” a period of partial nonenforcement for the new inpatient admission requirements, including the two-midnight rule, through the end of...more

MedPAC Recommends Reduction To Hospital Outpatient Department, LTCH Payment Rates, Increases To Inpatient Acure Care Hospital...

On January 16, the Medicare Payment Advisory Committee (MedPAC) unanimously voted to recommend that Congress direct the Secretary of Health and Human Services to...more

Two Midnight Rule Updates and How to Preserve Rights to Challenge Rule

Last month, CMS updated its FAQs related to the two midnight rule. In additional, CMS conducted two recent Open Door Forum Calls related to the new rule. Some of the highlights from the updated FAQs and calls are discussed...more

Medicare to Deny Certain Hospital Inpatient Claims for Hospice Patients

Under new CMS guidance, hospitals may have certain claims denied for inpatient services to a hospice patient. On November 7, 2013, CMS issued Change Request 8273 announcing changes in Medicare’s claims processing systems that...more

CMS Issues Additional Guidance Related to 2-Midnight Rule

Earlier this month, CMS posted three new documents related to the 2-midnight rule for inpatient admissions on its webpage for inpatient hospital reviews: new FAQs, as well as CMS directions for selecting hospital claims for...more

CMS Releases Temporary Instructions for Implementation of Final Rule 1599-F for Part A to B Billing of Denied Hospital Inpatient...

On September 16, CMS released a Medicare Learning Network (MLN) article (SE 1333) detailing temporary instructions for the implementation of final rule 1599-FI relating to billing for Part B services that were provided during...more

CMS Adopts Final Rules for Inpatient Admissions and Inpatient Part B Billing

In its final IPPS rule for FY 2014 CMS adopts its earlier proposals regarding its two-midnight policy related to inpatient admissions and hospital billing under Part B following a denial of an inpatient stay. CMS discusses...more

2-Midnight Inpatient Admission Policy

Under CMS’s modified inpatient admission guidelines adopted in the IPPS Final Rule, Part A payment is “generally inappropriate” unless the patient is admitted based on the physician’s expectation that the patient will require...more

Part B Inpatient Billing in Hospitals

Introduction - On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) concurrently issued CMS Ruling Number CMS-1455-R (the Administrator’s Ruling) and a proposed rule, “Part B Inpatient Billing in...more

16 Results
|
View per page
Page: of 1