IPPS

News & Analysis as of

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

CMS Re-Opens Open Payments System

As my colleague Brian Dunphy previously reported, CMS temporarily closed the Open Payments system earlier this month. Open Payments is the online system through which pharmaceutical and device manufacturers covered by the...more

CMS Releases FY 2015 Hospital Inpatient Prospective Payment System (IPPS) Final Rule

On August 4, 2014, CMS released the annual Hospital Inpatient Prospective Payment System Final Rule for FY 2015 (the “Final Rule”) affecting discharges occurring on or after October 1, 2014. For inpatient acute care...more

CMS Publishes FY 2015 Final IPPS Rule

On August 4, 2014, CMS posted its final changes and updates to the Medicare Inpatient Prospective Payment System (IPPS) that apply for fiscal year (FY) 2015, effective October 1, 2014. Below are some of the highlights of the...more

Health Headlines: Also in the News - August 2014

Hospital IPPS Final Rule Not Yet Released – As of the time this edition of Health Headlines was sent to press, CMS has not yet released the hospital inpatient prospective payment system (IPPS) final rule for FY 2015....more

The Probe and Educate Process For The Two-Midnight Rule

On August 2, 2013, the Centers for Medicare and Medicaid Services (“CMS”) released the final rule for the 2014 Medicare Inpatient Prospective Payment System (“IPPS”), effective October 1, 2013.[1] Introduced in the IPPS...more

D.C. Circuit Overturns PRRB’s Decision that Only Newly Built Hospitals Can Qualify for Favorable Capital Reimbursement Rates

In Select Specialty Hospital – Bloomington, Inc. v. Burwell, No. 15-5355 (D.C. Cir., Jul. 8, 2014), a group of long-term care hospitals (LTCHs) successfully challenged the Secretary’s determination that they were not “new...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

CMS Announces Payment Adjustments for Low-Volume and Medicare-Dependent Hospitals

In a notice posted on June 12, 2014, CMS announced changes to the payment adjustment provided to low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment...more

CMS Proposal to Adopt New OMB Delineations May Affect Medicare Reimbursement, GME Payments, and Regulatory Compliance

On April 30, 2014, the Centers for Medicare and Medicaid Services (CMS) issued proposed rules for the Fiscal Year 2015 Medicare Hospital Inpatient Prospective Payment System, in which CMS announced several updates, including...more

Changes Proposed to PRRB Dissatisfaction Requirement

On May 15, 2014, CMS published in the Federal Register its FY 2015 IPPS Proposed Rule [PDF], which included changes and updates to its Medicare IPPS policies. 79 Fed. Reg. 27978-28384. One change that CMS proposes is to amend...more

Proposed 2015 IPPS Rule Contains Many Changes to GME and IME Rules

Each year when CMS publishes its proposed changes to the IPPS Rule, it suggests a number of graduate medical education (GME) and indirect medical education (IME) reforms. This year has been no different. As part of the IPPS...more

Oh Baby: Medicare Wants to Focus on Early Elective Deliveries

Deep within the proposed FY 2015 Inpatient Prospective Payment System (IPPS) rule released a few weeks back is an interesting proposed new measure to the Medicare hospital Value-Based Purchasing (VBP) program – elective...more

CMS's Proposed Adoption of New Geographic Areas Likely to Have Significant Reimbursement Effects

In its proposed FY 2015 inpatient prospective payment system (IPPS) rule, CMS asserts its intent to adopt the most recent labor market area delineations issued by the Office of Management and Budget (OMB), which utilize 2010...more

CMS Publishes Inpatient Prospective Payment System (IPPS) FY 2015 Proposed Rule

On April 30, 2014, CMS posted its proposed changes and updates to the Medicare IPPS [PDF] that would apply beginning in fiscal year (FY) 2015. Comments are due by June 30, 2014. Below is a summary of the major changes to the...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

The push for greater transparency in healthcare continues

Recently, CMS released the proposed fiscal year 2015 Inpatient Prospective Payment System (IPPS) rule for inpatient stays in long-term and general acute care hospitals. Included among the regular updates to Medicare payment...more

CMS Says ICD-10 Will Be Implemented on October 1, 2015

According to CMS, the transition from the ICD-9 to the ICD-10 diagnosis coding system is set to occur on October 1, 2105. The ICD-10 transition was originally scheduled for October 1, 2013, but has been delayed a number of...more

CMS Releases Proposed IPPS and LTCH Rule

On April 30, 2014, CMS released the much anticipated proposed Hospital Inpatient Prospective Payment System rule (“Proposed IPPS Rule”), which would apply to FY 2015 Medicare payments. For inpatient acute care hospitals, CMS...more

Judge Ends Indirect Purchaser Plaintiffs’ Case in Refrigerant Compressors

Last week, on April 8, 2014, the District Court for the Eastern District of Michigan dismissed the remaining claims of indirect purchaser plaintiffs (IPPs) in the ongoing Refrigerant Compressors litigation. In re:...more

King & Spalding Files Court Challenge to 0.2 Percent IPPS Rate Reduction

On March 25, 2014, King & Spalding filed a complaint in the United States District Court for the District of Columbia challenging CMS’s 0.2 percent reduction to FY 2014 IPPS payment rates associated with the two-midnight...more

CMS Requests Re-Review of Two-Midnight Probe & Educate Denials and Releases Additional Guidance

On February 24, 2014, CMS released additional guidance addressing implementation of the revised inpatient hospital admission standards adopted in the 2014 IPPS Final Rule and new instructions to the Medicare Administrative...more

CMS Extends Time for Probe Audits of Inpatient Admissions, and Clarifies Inpatient Order and Certification Requirements

Probe and Educate Audits of Inpatient Admissions Extended - CMS announced on its Inpatient Hospital Review website on Friday that it was extending the probe and education audits of inpatient admissions for an...more

CMS Again Delays Implementation of Controversial “2 Midnights Rule"

Hospitals gearing up for implementation of the “2 Midnights Rule” have more time to prepare—or consider joining efforts to modify or rescind the rule—now that CMS has delayed implementation for a third time....more

"Incident To" Personnel and Credentials: CMS's New Teeth to Address an Old Problem

Medicare’s “incident to” provision found at 42 U.S.C. § 1395x(s)(2)(A) addresses coverage of services and supplies furnished “incident to a physician’s professional service,” principally in a physician’s office or clinic....more

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