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  • Hospital Outpatient Supervision Level Designations: April 30 Deadline for Comments
    Based on the Hospital Outpatient Payment (HOP) Panel’s recommendations at its meeting on March 10, 2014, CMS is proposing changes to certain current outpatient supervision level requirements described in the CY 2012 Hospital Outpatient Prospective Payment System /Ambulatory Surgical Center Final Rule. The requirements open to public comment are outlined in CMS’ Preliminary Decisions on the Recommendations of the Hospital Outpatient Payment Panel on Supervision Levels for Select Services. Comments may be submitted via email to through 5pm ET on April 30, 2014. As indicated in the final rule, CMS will consider any comments and post final decisions that will be effective on July 1, 2014.
  • 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-1601-FC: Hospital Outpatient Payment System (OPPS) and CY 2014 Payment Rates (Display Date: November 27, 2013; Publication Date: December 10, 2013)
  • Deadline for LTCH/IRF 1st Quarter Quality Data Extended to Friday August 23

    CMS is extending the deadline for Long-Term Care Hospitals (LTCHs) and Inpatient Rehabilitation Facilities (IRFs) submitting first quarter 2013 (January – March) quality data to 11:59:59 p.m. on August 23, 2013. The original deadline was 11:59:59 on August 15, 2013. Due to data submission challenges with both CMS reporting and the National Healthcare Safety Network systems, the extension applies to both clinical data and data on healthcare-associated infections.

  • 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 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:

    FY 2014 IPPS Rule Outreach

    Final Rule (CMS-1599-F)

  • CMS-1599-F: Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions Participation (Display Date: August 2, 2013)
  • CMS-1448-F: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014 (Display Date: July 31, 2013)
  • CMS-1447-N: FY 2014 Inpatient Psychiatric Facilities Prospective Payment System - Rate Update (Publication Date: August 1, 2013)
  • 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

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