CMS IPPS 2014 Final Rule

Recommendations

Info

Additional Guidance• Expect “sub-regulatory guidance” (i.e., more detailed information) inthese areas:– “Objective medical information” Page 50944, IPPS– Transfers and impact on 2 midnights Page 50948, IPPS– Refunding the part A deductible to the patient if rebilling for partB Page 50919, IPPS– Verbal orders for inpatient admissions Page 50941, IPPS– Stays expected to last less than 2 midnights are generallyinappropriate for inpatient hospital admission (plan to explainsituations when < 2 MN is appropriate for inpatient) Page50946, IPPS– Documentation expectation and Auditor focus areas CMS OpenDoor Forum22
UR Chart ReviewCOPs Must Be Followed• “We did not propose and are not finalizing a policy that wouldallow hospitals to bill Part B following an inpatient reasonableand necessary self-audit determination that does not conformto the requirements for utilization review under the CoPs.”Page 50913, IPPS• 482.30 (1) The UR plan must provide for review for Medicareand Medicaid patients with respect to the medical necessityof:(i) Admissions to the institution;(ii) The duration of stays;23
Page 1 and 2: CMSIPPS 2014 Final RuleAHA Solution
Page 4 and 5: 2-Midnight Benchmark• “…[W]e
Page 6 and 7: Benchmark vs. Presumption• “Ben
Page 9 and 10: Order and Certification• “(c) T
Page 11 and 12: Prohibits Partial PaymentOrders•
Page 13 and 14: Rebilling - Claims ImpactedClaims a
Page 15 and 16: Beneficiary Impact“Beneficiaries
Page 17 and 18: Balance Bill the Patient?• “…
Page 19 and 20: IPPS impact on IRF and LTCH• With
Page 21: Effective October 1, 2013• Mainta
Page 25 and 26: Admission Review Vital• Cannot be
Page 27 and 28: Status Order Improvement• Conside
Page 29 and 30: Expectation/Certification• Physic
Page 31 and 32: Documentation - Efficiency• For c
Page 33 and 34: Review Considerations• Review cas
Page 35 and 36: Summary• Understand the new regul
Page 37 and 38: Appendix37
Page 39 and 40: Table of Contents* (con’t)12. Reg
Page 41 and 42: Get the Latest IndustryNews & Updat
Page 43: ©2013 Executive Health Resources,

CMS IPPS 2014 Final Rule

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