Patient Prospective Payment System

News & Analysis as of

CMS Expands Payment Reform to Outpatient Care in New RFI

Citing the need to complement a portfolio of pilot projects that focus mostly on primary care and the inpatient setting, CMS released a Request for Information (RFI) on February 11th, seeking input on potential payment and...more

MedPAC Issues Draft Recommendations For 2015 Medicare Payments

The Medicare Payment Advisory Commission (MedPAC) met on December 12-13, 2013, to discuss draft recommendations regarding 2015 payment updates for Medicare providers. MedPAC, which is responsible for issuing an annual...more

CMS "Packages" Clinical Laboratory Tests Into Outpatient Prospective Payment System

Hospitals Lose Right to Bill Separately for Laboratory Tests for Outpatients - As part of its calendar year 2014 hospital outpatient prospective payment system (OPPS) policy changes, the Centers for Medicare & Medicaid...more

CMS Outpatient and Physician Payment Rules: Don't Miss the Efficient Quality of Care Reform Forest for the Dollar Trees

The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more

CMS Releases CY 2014 Hospital OPPS and ASC Final Rule

CMS has published its Calendar Year (CY) 2014 Final Rule for Medicare policy and payment rates for hospital outpatient prospective payment systems (OPPS) and Ambulatory Surgical Center (ASC) services. This final rule with...more

Publication of Home Health Prospective Payment System Final Rule

On December 2, 2013, the Federal Register published CMS’s final rule regarding the home health prospective payment system (PPS) and home health quality reporting requirements. The final rule reduces payments under the PPS by...more

CMS Announces New Cost Reporting Procedures to Address DSH Uncompensated Care Payments

In the fiscal year 2014 Inpatient Prospective Payment System (IPPS) rule (the “final rule”), CMS explained the new disproportionate share hospital (DSH) payment methodology that took effect this October 1. As we reported in...more

CMS's Two-Dog Night - Doctor Told Me Not to Stay as an Inpatient for Less Than Two Nights

The Centers for Medicare and Medicaid Services (CMS) recently issued controversial new criteria for hospitals to use to determine whether a patient's stay in a hospital should be treated as an outpatient observation stay or...more

FY 2014 IPPS/LTCH PPS Final Rule Goes Into Effect October 1, 2013

In This Issue: - What Providers Should Know - Requirements for Inpatient Admissions and Payment Under Medicare Part A - New Rules Permitting Re-billing Under Medicare Part B for Denied Admissions - New HAC...more

Federal District Court Rules Against Medicare Beneficiaries Challenging Observation Status

In Bagnall v. Sebelius, No. 3:11-CV-01703 (D. Conn.), a federal district court in Connecticut recently granted a motion to dismiss the complaint of fourteen Medicare beneficiaries seeking to invalidate an HHS policy allowing...more

Three-Month Implementation Period for “Two-Midnight” Rule to Begin October 1, 2013

CMS issued guidance on September 26, 2013, regarding the implementation of the “Two-Midnight” rule addressed in the August 2013 Inpatient Prospective Payment System (IPPS) final rule. Under the Two-Midnight rule, patient...more

CMS Issues Inpatient Admission Order and Certification Guidance

On September 5th of this year, CMS issued guidance [PDF] addressing hospital inpatient admission orders and certifications. The regulations addressing certifications at 42 C.F.R. §§ 424.13 – 424.16 were revised as part of the...more

CMS Issues Guidance Concerning Inpatient Admission Order and Certification Requirements

On September 5, 2013, CMS issued guidance concerning its new inpatient admission order and certification policies. As previously reported, CMS adopted new policies governing inpatient admissions, including inpatient...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

CMS Releases FY 2014 Medicare Final Inpatient Rehabilitation Facility Payment Regulations and Rates

On July 31, CMS released a final rule that will increase Medicare payments to Inpatient Rehabilitation Facilities (IRFs) by an estimated 2.3 percent, or $170 million, in Fiscal Year 2014. ...more

CMS Proposes Increase in Payments for SNFs in FY 2014

On May 1, 2013, CMS issued a proposed rule that would update payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2014. The proposal would increase aggregate...more

CMS Proposes Prospective Payment System Update Rules for Inpatient and Long Term Care Hospitals

On Friday, April 26, the Centers for Medicare and Medicaid Services (CMS) issued a crucial payment system rule that proposes updated rates and regulatory policies for inpatient hospitals (including inpatient psychiatric...more

CMS Releases Proposed FFY 2014 IPPS Rule

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a net increase in operating payments...more

Resubmission of Hospital Claims

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

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