- Critical Access Hospitals: Bill Correctly
An Office of Inspector General report found that Medicare improperly paid CAHs and health care professionals for the same CAH services. A CAH can only bill for facility and professional outpatient services if the physician or practitioner reassigns their billing rights to them.
View the Provider Compliance Fast Fact.
Clinical Laboratory Data Reporting: Enforcement Discretion
On March 30, CMS announced that it will exercise enforcement discretion until May 30, 2017, with respect to the data reporting period for reporting applicable information under the Clinical Laboratory fee Schedule (CLFS) and the application of the Secretary’s potential assessment of civil monetary penalties for failure to report applicable information.View the announcement (PDF) and PAMA regulations page.
- Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions (PDF)
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 (PDF) 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 (PDF)
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 web page 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:
FY 2014 IPPS Rule Outreach (PDF)
Final Rule (CMS-1599-F)
- Quality, Safety & Oversight - General Information
- Critical Access Hospitals
- Form CMS-2802E - Request for Validation of Accreditation for Critical Access Hospital Survey
- Physician Bonuses
- MLN Matters Article SE0453 (PDF) : MMA-Proposed Implementation of the Physician Scarcity Bonus and Revision to the Health Professional Shortage Area (HPSA)
- Skilled Nursing Facility PPS
- MLN Matters® Article SE1606 – Guidance on the Physician Quality Reporting System (PQRS) 2014 Reporting Year and 2016 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs) (PDF)
- Physician Regulatory Issues Team (PRIT)
- Choosing to Convert to Critical Access Hospital Status -- Health Care Financing Review: Fall 2003 Edition Article
How to Stay Informed
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- Hospitals Open Door Forum
- Internet-Only Manuals (IOMs)
- Claims Processing Manual - clm104c04 (PDF) - Special Rules for Critical Access Hospital Outpatient Billing