- MLN Connects™ National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014 at 1:30 pm ET). This MLN Connects™ National Provider Call provides an overview of certifying patient eligibility for the Medicare home health benefit. This includes an overview of a new requirement for HHAs to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility. This new requirement was finalized in the Calendar Year 2015 Home Health Prospective Payment System final rule (CMS-1611-F) effective for home health episodes beginning on or after January 1, 2015. For more information and to register, visit this MLN Connects™ National Provider Call web page.
- CMS-1613-FC: Hospital Outpatient Prospective Payment- Final Rule with Comment Period and CY2015 Payment Rates
- Register for the third national provider call titled “Hospital Appeals Settlement Update 2” to be held Tuesday October 21: 1-2:30pm ET.
- CMS-1607-F: Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates
- CMS-1608-F: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015
- CMS-1606-F : FY 2015 Inpatient Psychiatric Facilities Prospective Payment System – Rate Update
- CMS-1613-P: Hospital Outpatient Payment System (OPPS) and CY 2015 Payment Rates
- CMS-1607-P: Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates
- Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
On August 19, 2013, in the FY2014 IPPS/LTCH final rule CMS clarified and revised the conditions of payment for hospital inpatient services under Medicare Part A related to patient status. On September 5, 2013, CMS released guidance that discussed the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services. This document includes further clarification of issues addressed in the previous guidance.
- Prior Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
The guidance provided in this document has been further clarified in Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions. This version of the guidance document will remain online for comparison purposes.
CMS Rule 1599-F: Inpatient Hospital Admission and Medical Review Criteria (2-Midnight Provision) and Part B Inpatient Billing in Hospitals
CMS hosted a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to give feedback on the physician order and physician certification, inpatient hospital admission and medical review criteria, and Part B inpatient billing provisions that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule (CMS-1599-F). This introductory call allowed for initial discussions between stakeholders and CMS. The transcript and MP3 audio file will be posted to the Special ODF webpage under the "Downloads" section around August 22 and will be available for 30 days. CMS understands that providers or associations may have additional questions or concerns. You are encouraged to submit questions related to the two midnight provision for admission and medical review to the IPPSadmissions@cms.hhs.gov mailbox. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule. CMS will review stakeholder feedback as quickly as possible and provide responses and clarification as needed.
For more information:
- On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) issued Ruling 1455-R which establishes an interim process for hospitals to bill Medicare for Part B services following a denial of a claim for an inpatient admission as not reasonable and necessary. CMS has issued temporary billing instructions for affected providers to follow for both the Part B Types of Bills (TOB), TOB 12x and TOB 13x.
- Revised Fact Sheet for Referral Agents - Where are the Round 2 areas? What if a beneficiary travels? What do you need to know before prescribing a DMEPOS item or referring the beneficiary to a DMEPOS supplier? Want more information on the national mail-order program for diabetic testing supplies?
- For answers to these questions and more, see the revised “Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program: Referral Agents” Fact Sheet (ICN 900927), which is now available in downloadable format.
- CMS-1442-N - Changes to Wage Indices and Hospital Reclassifications Impacting Certain OPPS Hospitals.
- Blood Clotting Factor Furnishing Fee
MLN Connects Provider eNews Spotlights
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Acute Inpatient PPS -- New Medical Services and New Technologies and Hospital-Acquired Conditions (Present on Admission Indicator)
- Critical Access Hospitals Center
- Hospital Outpatient PPS
- Long-Term Care Hospital PPS
- Inpatient Rehabilitation Facility PPS
- Inpatient Psychiatric Facility PPS
- Electronic Billing & EDI Transactions : Medicare information on electronic transactions under HIPAA
- Historical Part B Drug Pricing Files
- Transplant Centers
- Service Furnished to Undocumented Aliens
Enrollment, Participation & Certification
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Critical Access Hospitals
- Psychiatric Hospitals
- Survey & Certification - General Information
Policies & Regulations
- IPPS Regulations and Notices
- Hospital Outpatient Regulations and Notices
- List of IRF Federal Regulations
- LTCHPPS Regulations and Notices
- IPF PPS Regulations and Notices
- Quarterly Provider Updates
- HCPCS - General Information
- Alpha-Numeric HCPCS
- ICD-9-CM and ICD-10
- Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) - Opens in a new window
- MLN General Information
- MLN Educational Web Guides
- MLN Matters Articles ( Search Tips )
- MLN Products
- Medicare Coverage - General Information
- Medicare Coverage Database - Opens in a new window
- National Coverage Determinations (NCD) Manual - Pub. 100-03
Physician Self Referrals -- Specialty Hospitals
- Physician Self Referral
- Disclosure of Financial Relationships Report (DFRR)
- Specialty Hospital Issues
- Specialty Hospital Advisory Opinions
CMS Manuals & Transmittals
National Provider Identifier (NPI)
Hospital Value-Based Purchasing
- Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program [PDF, 743KB]
- Agenda - April 12, 2007 Listening Session [PDF, 17KB]
- Slide Presentations - April 12, 2007 Listening Session [ZIP, 465KB]
- Options Paper 2nd Public Listening Session [PDF, 208KB]
- Agenda - January 17, 2007 Listening Session [PDF, 22KB]
- Slide Presentations - January 17, 2007 Listening Session [ZIP, 932KB]
- Issues Paper for the January 17, 2007 Listening Session on a Plan for Medicare Hospital Value-Based Purchasing [PDF, 277KB]
- Special Forum on Hospital Value Based Purchasing [PDF, 212KB]
- Hospital Quality Initiative
- Beneficiary Notices Initiative (BNI)
- Prevention - General Information
- Provider resources
Medical Review/ Fraud & Abuse
- Beneficiary Complaint Response Program