News & Analysis as of

Patient Prospective Payment System Hospitals

McDermott+

McDermottPlus Check-Up: August 4, 2023

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Congress is officially in recess for the month of August and will return after Labor Day. On the regulatory front, the Centers for Medicare & Medicaid Services (CMS) released the final fiscal year (FY) 2024 Inpatient...more

Baker Donelson

OIG Finds Continued Procedural Errors in Hospital Outlier Payment Reconciliations

Baker Donelson on

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently released a report concluding that there are vulnerabilities in the process of reconciling Medicare hospital outlier payments....more

Sheppard Mullin Richter & Hampton LLP

CMS Releases 2017 Medicare Hospital Payment Rates, Penalties for Poor Performers

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) modifying the Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

Baker Donelson

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

Baker Donelson on

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

McGuireWoods LLP

Budget Act Significantly Impacts Provider-Based Facility Reimbursement

McGuireWoods LLP on

On November 2, President Obama signed into the law the Bipartisan Budget Act of 2015 (the “Act”), which contains language that will significantly change how hospital-based outpatient care is reimbursed....more

Arnall Golden Gregory LLP

CMS Implements Changes to Prospective Payment System for Long-Term Care Hospitals

The Centers for Medicare & Medicaid Services (CMS) has implemented a revised payment system for Long-Term Care Hospitals (LTCHs). The changes, which became effective on October 1, define two separate payment categories for...more

Baker Donelson

CMS Issues FY 2016 Final Inpatient and Long-Term Care Hospital Rule

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On July 21, 2015, CMS issued a final rule updating the fiscal year (FY) 2016 Medicare payment polices and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment...more

Baker Donelson

CMS Issues CY 2016 Proposed Rule for OPPS, ASC Payment Systems and Quality Reporting

Baker Donelson on

On July 8, 2015, CMS published in the Federal Register [PDF] its proposed changes and updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy...more

Davis Wright Tremaine LLP

Changes to the “Two-Midnight Rule” on the Horizon

On July 1, CMS published proposed changes to the so-called “Two-Midnight Rule,” which currently governs when inpatient hospital admissions are entitled to Medicare Part A payment. The proposed changes were announced in a...more

King & Spalding

CMS Issues FY 2016 IPPS and LTCH Proposed Rule

King & Spalding on

On April 17, 2015, CMS released a proposed rule (Proposed Rule) to update the fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital...more

King & Spalding

Representative Brady Introduces Discussion Draft of the Hospital Improvements for Payment Act of 2014

King & Spalding on

On November 19, 2014, House Ways & Means Health Subcommittee Chairman Kevin Brady introduced a 146-page discussion draft of the Hospital Improvements for Payment Act of 2014 (HIP). HIP seeks to, among other things, make...more

Baker Donelson

Highlights of the 2015 OPPS and ASC Final Rule

Baker Donelson on

On October 31, 2014, CMS published its 2015 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule. This annual rule affects the 4,000...more

BakerHostetler

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

BakerHostetler on

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

Baker Donelson

CMS Releases CY 2014 Hospital OPPS and ASC Final Rule

Baker Donelson on

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

Baker Donelson

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

Baker Donelson on

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

BakerHostetler

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

BakerHostetler on

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

Polsinelli

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

Polsinelli on

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

King & Spalding

Federal District Court Rules Against Medicare Beneficiaries Challenging Observation Status

King & Spalding on

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

King & Spalding

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

King & Spalding on

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

Baker Donelson

CMS Issues Inpatient Admission Order and Certification Guidance

Baker Donelson on

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

King & Spalding

2-Midnight Inpatient Admission Policy

King & Spalding on

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

Cozen O'Connor

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

Cozen O'Connor on

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

Baker Donelson

CMS Releases Proposed FFY 2014 IPPS Rule

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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

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